Computerized refraction and astigmatism determination

ABSTRACT

The present disclosure relates generally to systems and methods for determining the refractive error of a patient, more particularly determining the patient&#39;s refractive error by using a computerized screen, and providing a prescription for the patient&#39;s preferred type of corrective lenses. In a general embodiment, the present disclosure provides a method for determining a corrective lenses prescription of a patient. The method includes, separately, for each eye of the patient, determining an astigmatism prescription for the patient via a computerized screen and without the use of a refractor lens assembly, including instructing the patient to move a known, fixed distance away from a computerized screen and testing for a cylinder component by sequentially presenting at least two cylinder diagrams to the patient via the computerized screen and enabling the patient to select at least one input per cylinder diagram, where those inputs correspond to cylinder measurements for determining the prescription.

PRIORITY CLAIM

This non-provisional patent application is a continuation of U.S. patentapplication Ser. No. 15/292,574, titled “COMPUTERIZED REFRACTION ANDASTIGMATISM DETERMINATION,” filed Oct. 13, 2016, which is a continuationof U.S. patent application Ser. No. 14/856,849, titled “COMPUTERIZEDREFRACTION AND ASTIGMATISM DETERMINATION,” filed Sep. 17, 2015, now U.S.Pat. No. 9,492,074 issued Nov. 15, 2016, and further claims priority toand the benefit of U.S. Provisional Patent Application Ser. No.62/155,080, titled “COMPUTERIZED REFRACTION AND ASTIGMATISMDETERMINATION,” filed on Apr. 30, 2015; the entire contents of both ofwhich are expressly incorporated herein by reference.

BACKGROUND

The present disclosure is generally related to determining a glassesand/or a contacts prescription for a patient with a refractive error inneed of correction. Many people have refractive errors of the eye whichcause them to be either myopic (commonly known as nearsightedness) orhypermetropic (commonly known as farsightedness). One of ordinary skillin the art will understand that myopia refers to a refractive defect ofthe optical properties of an eye that causes images to focus forward ofthe retina (i.e. a refractive error). Those optical defects aretypically caused by, among other things, defects of the cornea,elongation of the eye structure, other conditions, or a combination ofthose conditions. Hyperopia, on the other hand, refers a refractiveerror of the optical properties of an eye that causes images to focusbehind the retina. Those optical defects are the result when the opticsof the eye are not strong enough for the front to back length of theeye. Myopia and hyperopia have one component, a sphere measurement,which indicates the strength or power necessary to correct for theoptical defects.

Astigmatism refers to a refractive error that causes light entering theeye to focus on two points rather than one. It is caused by an unevenpower of the cornea. An astigmatism has two components, an axismeasurement, which indicates the angle along which any image viewed bythe patient is distorted, and a cylinder measurement, which indicatesthe strength or power of the distortion. Myopia, hyperopia, andastigmatism are the principle refractive errors that cause patients toseek treatment to correct their vision problems.

A manifest refraction analysis is a diagnostic tool used byophthalmologists and optometrists whereby a patient's refractive erroris tested to indicate whether the patient would benefit from correctionwith glasses or contact lenses. As part of that technique, a patientlooks through a phoropter while the ophthalmologist or optometristevaluates each of the patient's eyes. A retinal reflex diagnosistechnique is often used to assess the magnitude of the refractive errorpresent in the patient's eyes. Subjective feedback from the patient isused to refine the manifest refraction, which involves the patientmaking choices between image quality as different lenses havingdifferent powers are slid into place in the phoropter. These refractiveerrors can be corrected with lenses, typically spectacle lenses, knownas glasses, or contact lenses, which are applied directly to the eye.They can also be corrected with various types of surgery. At the end ofthe manifest refraction analysis, the ophthalmologist or optometrist mayproduce a prescription for glasses, contact lenses, and/or refractivesurgery.

Other methods for determining the refractive error of a patient includeknown diagnostic devices such wavefront sensors, refractometers, andothers that are well known in the art. Some of these diagnostic devicesuse computers to assist in determining the refractive error of thepatient. For example, one implementation of a wavefront-type refractorthat is well known in the art uses a “Hartmann-Shack” sensor to measurethe wavefront of a light beam generated from an illumination spotprojected on the retina and passed through the eye's optics. In such awavefront type refractor, a probe beam from a laser or asuper-luminescent diode is projected onto the retina through the eye'soptics. Light scattered by the retina passes through the eye's optics,and emerges through the eye's pupil. The wavefront of the emerging beamcarries refractive information relating to the eye's optics. Forexample, if the eye is emmetropic (i.e., the eye's optics are withoutrefractive error), the wavefront of the emerging beam should be flat.Relay optics relay the wavefront emerging from eye's pupil onto theHartmann-Shack sensor. The Hartmann-Shack sensor measures the distortionof the wavefront and provides that information to a computer to computethe refractive errors of the eye due to aberrations of the eye's optics.

Each of the above-described techniques for determining a patient'srefractive error requires the patient to travel to a place where suchmachines or doctors are present and available to perform thedetermination. And, having traveled to a doctor's office, a patient thenhas to pay for the time and services of the doctor, which may or may notbe covered by their health insurance. This can be both expensive andinconvenient for a patient.

For a patient who desires contacts, a second charge generally appliesfor a “fitting.” This charge is frequently unnecessary because mostcontacts manufacturers only offer one or a few base curve and diametercombinations, meaning there is only one or a few possible “fits” forthat contact. When a patient has worn contacts before and is comfortablein their previous brand, there is no need to perform a “fitting.”Despite this, it is commonly required by doctor's offices that a“fitting” be performed, and the accompanying fee charged. Healthinsurance seldom covers this fee. In some cases, the doctor may requirethat the patient make another, separate office visit to have their“fitting.” Therefore, determining a contacts prescription can be evenmore expensive and inconvenient for a patient.

In addition, the cost of the above described machinery (phoropter,wavefront refractor, etc.) is prohibitive to ownership by an individualnot engaged in a medical practice, so patients do not have the option ofdetermining their own glasses or contacts prescription outside of amedical practice setting.

Furthermore, in-office subjective astigmatism tests generally onlydetermine a patient's axis prescription within 10° of accuracy.

Thus, there exists a need for a more convenient, less costly, moreaccurate way for patients to determine and receive glasses and contactsprescriptions.

SUMMARY

The present disclosure relates generally to a system and method fordetermining the refractive error of a patient, more particularlydetermining the patient's refractive error by using a computerizedscreen or other suitable visual tool, and without the use of a refractorlens assembly, and providing the patient with a corrective lensesprescription for the patient's preferred type of corrective lenses. Thesystem and method do not require the trip or expense of a doctor visit,and are optimized for convenience and cost effectiveness.

In a general embodiment, the present disclosure provides a method fordetermining a corrective lenses prescription of a patient. The methodincludes, separately, for each eye of the patient, determining theastigmatism prescription of the patient via a computerized screenwithout the use of a refractor lens assembly.

In an embodiment, determining the astigmatism prescription of thepatient via the computerized screen and without the use of a refractorlens assembly includes testing for a cylinder component and an axiscomponent at the same time by presenting at least one diagram to thepatient via the computerized screen and enabling the patient to selectat least one input per diagram. The at least one input per diagramcorresponds to a cylinder measurement and an axis measurement used todetermine the cylinder component and the axis component of thecorrective lenses prescription for the patient.

In a further embodiment, the cylinder component is based, at least inpart, on the cylinder measurements from the at least one input perdiagram. In another further embodiment, the axis component is based, atleast in part, on the axis measurements from the at least one input perdiagram.

In a further embodiment, presenting the at least one diagram includessequentially presenting at least two diagrams having at least twoportions. In another further embodiment, the at least two diagramsdiffer from each other by at least the spacing between the at least twoportions. In a still further embodiment, the at least two diagrams arethe same diagram.

In a further embodiment, the method includes determining a pupillarydistance measurement for the patient based on a known canthal distance(based on an age and a gender of the patient) and at least onecalibration data point.

In an embodiment, the method is provided via an interne.

In an embodiment, the method includes sending the determined cylindercomponent and the determined axis component of the corrective lensesprescription for the patient to at least one doctor for review andapproval.

In another further embodiment, the method includes determining a spherecomponent of the corrective lenses prescription for the patient via thecomputerized screen. The method includes (i) presenting a first figureto a patient via the computerized screen. The first figure is too smallto be clearly seen by the patient. The method further includes (ii)enabling the patient to make at least one input to increase the size ofthe first figure until it can just barely be made out by the patient.The at least one input corresponds to a first sphere measurement.

In a still further embodiment, the method includes (iii) presenting asecond figure to a patient via the computerized screen. The secondfigure is large enough to be clearly seen by the patient. The method(iv) enables the patient to make at least one input to decrease the sizeof the second figure just until it can no longer be made out by thepatient. The at least one input corresponds to a second spheremeasurement.

In another further embodiment, the method includes determining a finalsphere measurement based, at least in part, on the first spheremeasurement and the second sphere measurement. In yet another furtherembodiment, the method includes repeating at least one of steps (i) and(ii), or steps (iii) and (iv) at least once.

In a further embodiment, the method includes that the computerizedscreen is located a distance from the patient, in a kiosk. In anotherfurther embodiment, the method includes instructing the patient to takea determined number of heel-to-toe steps from the computerized screen toreach the distance. In a still further embodiment, the determination ofthe number of heel-to-toe steps is based on at least a shoe size of thepatient.

In another further embodiment, determining the corrective lensesprescription for the patient is based, in part, on a previous correctivelenses prescription for the patient.

In another embodiment, the present disclosure provides a non-transitorycomputer readable medium. The non-transitory computer readable mediumincludes a plurality of instructions, which when executed by at leastone processor, cause the at least one processor to operate with at leastone display device, at least one memory device, and at least one inputdevice to determine a corrective lenses prescription of the patientwithout the use of a refractor lens assembly. The corrective lensesprescription comprises an astigmatism prescription and a power. Thenon-transitory computer readable medium determines the corrective lensesprescription of the patient by, for each eye of the patient, determiningthe astigmatism prescription of the patient. The non-transitory computerreadable medium determines the astigmatism prescription of the patientby presenting at least one diagram to the patient via a computerizedscreen (without the use of a refractor lens assembly) and enabling thepatient to select at least one input per diagram. The patient-selectedinput corresponds to a cylinder measurement and an axis measurement usedto determine the corrective lenses prescription for the patient. Thenon-transitory computer readable medium further determines thecorrective lenses prescription of the patient by, for each eye of thepatient, determining the power of the corrective lenses prescription ofthe patient. The non-transitory computer readable medium determines thepower of the prescription by presenting a first figure to a patient viathe computerized screen. The first figure is too small to be clearlyseen by the patient. The non-transitory computer readable medium furtherdetermines the power of the prescription by enabling the patient to makeat least one input to increase the size of the first figure until it canjust barely be made out by the patient. The at least one inputcorresponds to a first sphere measurement. The non-transitory computerreadable medium further determines the power of the prescription bypresenting a second figure to a patient via the computerized screen. Thesecond figure is large enough to be clearly seen by the patient. Thenon-transitory computer readable medium further determines the power ofthe prescription by enabling the patient to make at least one input todecrease the size of the second figure just until it can no longer bemade out by the patient. The at least one input corresponds to a secondsphere measurement. The non-transitory computer readable mediumdetermines a final sphere measurement based, at least in part, on thefirst sphere measurement and the second sphere measurement.

In a further embodiment, the non-transitory computer readable mediumpresenting at least one diagram to the patient further includespresenting at least two diagrams. The at least two diagrams each includeat least two portions. The at least two diagrams differ from each otherby at least the spacing between the at least two portions.

In another further embodiment, the non-transitory computer readablemedium further determines a pupillary distance measurement for thepatient based on a known canthal distance based on an age and a genderof the patient and at least one calibration data point.

In a further embodiment, the non-transitory computer readable mediumfurther includes sending the determined corrective lenses prescriptionto at least one doctor for review and approval.

An advantage of the present disclosure is to provide a patient moreconvenience in determining and receiving a glasses and/or contactsprescription.

An advantage of the present disclosure is to reduce the cost and expenseto the patient of determining and receiving a glasses and/or contactsprescription.

Another advantage of the present disclosure is to determine a glassesand/or contacts prescription without the need for expensive equipmentonly feasible for use in a doctor office.

Another advantage of the present disclosure is to determine a glassesand/or contacts prescription without placing lenses or a lens assemblybefore the eyes of the patient.

Still another advantage of the present disclosure is to more quicklydetermine a glasses and/or contacts prescription.

A further advantage of the present disclosure is to more accuratelydetermine the axis and cylinder astigmatism prescriptions of a patient.

Additional features and advantages are described herein, and will beapparent from the following Detailed Description and the figures.

BRIEF DESCRIPTION OF THE FIGURES

FIGS. 1A and 1B are a flowchart illustrating an example method ofoperating an embodiment of the system of the present disclosure.

FIG. 2A illustrates a screen shot of an example of an embodiment of thesystem of the present disclosure, wherein the system displays requestsfor information regarding a prior prescription of the patient, aTillable form for the patient to enter data regarding their priorprescription, and requests for information regarding what refractiveerrors the patient may have.

FIG. 2B illustrates a screen shot of an example of an embodiment of thesystem of the present disclosure, wherein the system displays a requestfor information regarding a prior prescription of the patient and arequest for information regarding what refractive errors the patient mayhave.

FIG. 3 illustrates a screen shot of an example of an embodiment of thesystem of the present disclosure, wherein the system displays a diagramand enables a patient to make an input, wherein the input corresponds toan axis measurement of the patient.

FIG. 4A illustrates a screen shot of an example of an embodiment of thesystem of the present disclosure, wherein a diagram is shown as it wouldlook to a corrected eye with astigmatism, or to an eye withoutastigmatism.

FIGS. 4B, 4C, 4D, and 4E illustrate screen shots of examples ofembodiments of the system of the present disclosure, wherein eachdiagram is shown as it would look to an uncorrected eye with astigmatismalong a given axis.

FIG. 5 illustrates a screen shot of an example of an embodiment of thesystem of the present disclosure, wherein the diagram is shown as itwould look to a corrected eye with astigmatism after the patient hasmade at least one input, wherein the input corresponds to a cylindermeasurement of the patient.

FIG. 6 illustrates a screen shot of an example of an embodiment of thesystem of the present disclosure, wherein the system calibrates theamount of distance between a camera mounted to the computerized screenand the patient.

FIGS. 7A and 7B illustrate screen shots of examples of an embodiment ofthe system of the present disclosure, wherein the system displays afigure and enables a patient to make at least one input to change thesize of the figure, wherein the at least on input corresponds to asphere measurement of the patient.

FIGS. 8A, 8B, 8C, and 8D illustrate screen shots of examples of anembodiment of the system of the present disclosure, wherein the systemdisplays a colorblocked diagram and enables a patient to make at leastone input to select a more defined-appearing part of the diagram,wherein the input corresponds to a determination that the patient isnear or far sighted (if not wearing corrective lenses), over or undercorrected (if wearing corrective lenses), or otherwise.

FIG. 9A illustrates a screen shot of an example of an embodiment of thesystem of the present disclosure, wherein the system displays a figureand enables a patient to make at least one input to affect the rotationof the figure, wherein the at least one input corresponds to an axismeasurement.

FIG. 9B illustrates a screen shot of an example of an embodiment of thesystem of the present disclosure, wherein the system displays a figureand enables a patient to make at least one input to affect the spacingor size of various parts of the figure, wherein the at least one inputcorresponds to an cylinder measurement.

FIG. 10A illustrates a screen shot of an example of an embodiment of thesystem of the present disclosure, wherein the system displays whereinthe system displays a line diagram and enables a patient to make atleast one input, wherein the at least one input corresponds to acylinder measurement.

FIG. 10B illustrates a screen shot of an example of an embodiment of thesystem of the present disclosure, wherein the FIG. 10A is rotatable toalign with the determined axis of a patient's astigmatism.

FIG. 11A illustrates a screen shot of an example of an embodiment of thesystem of the present disclosure, wherein the system displays fine spokediagram, which is a smaller angular portion of spoke diagram of FIG.12B, and enables a patient to make at least one input, wherein the atleast one input corresponds to a fine axis measurement.

FIG. 11B illustrates a screen shot of an example of an embodiment of thesystem of the present disclosure, wherein the system displays aconcentric semi-circle diagram 1105 and enables a patient to make atleast one input, wherein the at least one input corresponds to an axisand/or a cylinder measurement.

FIG. 12A illustrates a screen shot of an example of an embodiment of thesystem of the present disclosure, wherein the system displays linediagram, and enables a patient to make at least two inputs, wherein theat least two inputs correspond to a cylinder measurement.

FIG. 12B illustrates a screen shot of an example of an embodiment of thesystem of the present disclosure, wherein the system displays a spokediagram 1205 and enables a patient to make at least one input, whereinthe at least one input corresponds to a gross axis measurement.

FIG. 13 illustrates a screen shot of an example of an embodiment of thesystem of the present disclosure, wherein the system displays linediagram 1304, and enables a patient to make at least one input, whereinthe at least one input corresponds to a cylinder measurement.

FIGS. 14A-D are screen shots of example embodiments of the system of thepresent disclosure which demonstrate that the alternating parts may beof different sizes or spacing, but still test for the same determinationin the astigmatism severity determination.

FIG. 15 is a screen shot of an example of an embodiment of the system ofthe present disclosure, which demonstrates that the alternating partsmay be of different sizes or spacing, but still test for the sameastigmatism axis determination.

FIG. 16 is a screen shot of an example of an embodiment of the system ofthe present disclosure, which demonstrates that an astigmatism axisgross determination figure may be modified in size and shape, andstretched in minor fashion, and still be usable by the system fordetermining an axis of astigmatism for a patient.

FIG. 17 is a screen shot of an example of an embodiment of the system ofthe present disclosure, which demonstrates a possible configuration fora macular degeneration test.

DETAILED DESCRIPTION

FIGS. 1A and 1B illustrate a flowchart of an example of a process ormethod 100 pursuant to an embodiment of the system of the presentdisclosure. In various embodiments, one or more processors execute a setof instructions to implement the process 100. Although process 100 isdescribed with reference to the flowchart shown in FIGS. 1A and 1B, thesystem may employ many other processes of performing the acts associatedwith this illustrated process. For example, the system may change theorder of certain of the illustrated blocks. The system can also makecertain of the illustrated blocks optional, the system may repeatcertain of the illustrated blocks, and/or the system may not employcertain of the illustrated blocks.

As indicated by block 102, the system displays on a computerized screena fillable form for a patient to make at least one input of a priorglasses or contacts prescription, contacts brand name, and/or contactsmanufacturer.

A computerized screen in accordance with an embodiment of the presentdisclosure includes, without limitation: a monitor, a televisiondisplay, a plasma display, a liquid crystal display (LCD), a displaybased on light emitting diodes (LEDs), a display based on a plurality oforganic light-emitting diodes (OLEDs), a display based on polymerlight-emitting diodes (PLEDs), a display based on a plurality ofsurface-conduction electron-emitters (SEDs), or any other suitableelectronic device or display mechanism. In certain embodiments, asdescribed above, the computerized screen includes a touch-screen. Itshould be appreciated that the computerized screen may be of anysuitable size, shape, and configuration.

The computerized screen displays a fillable form, fillable fields, orother vehicle for the patient to input data, if the patient has suchdata, including a prior glasses prescription, a prior contactsprescription, a prior contacts brand name, and/or a prior contactsmanufacturer. The data related to the prior contacts prescription can beinformation from a box of the patient's contacts, which they may stillhave in their possession. In one embodiment, the computerized screen ispart of a patient terminal, which the patient may use to access thesystem and process.

In another example embodiment, the fillable form may query the patientregarding their satisfaction with their current glasses or contactlenses, as well as how often they wear the glasses or contact lenses.

As indicated by block 104, the system receives at least one input of aprior glasses prescription, a prior contacts prescription, a priorcontacts brand name, and/or a prior contacts manufacturer. It should beappreciated that the system may automatically fill in or populate theform, fields, or other vehicle based on other data input by the patient.As one non-limiting example, the patient may input a prior contactsbrand name. The system may then use a look-up table or other method toretrieve from memory the corresponding base curve and/or diameteraspects of the prior prescription. This is especially possible withrespect to contacts brand names or manufacturers who provide only one ora few possible base curve and/or diameter sizes.

In one possible alternative to block 104, the system may receive aninput that the patient either does not have or does not wish to enterthe requested prior prescription information, as indicated by block 106.In one possible embodiment, block 106 is not a part of the process 100,and the patient must enter prior prescription information beforecontinuing to the next block. In another possible embodiment, block 106is part of process 100 and the patient is not required to enter anyprior prescription information before continuing to the next block.

The system displays on the computerized screen a query to the patientregarding whether they are nearsighted or farsighted, as indicated byblock 108, and receives at least one input from the patient in responseto the query regarding whether they are nearsighted or farsighted, asindicated by block 110.

At block 112, the system displays a first diagram to the patient on thecomputerized screen intended for a first eye (either right or left) ofthe patient. It should be appreciated that the patient should view thefirst diagram with their uncorrected first eye, i.e. if they wear glassor contacts, they should remove them and view the diagram without thecorrection of their glasses or contacts.

The system receives an input from the patient regarding how they viewthe first diagram with their first eye, wherein the input from thepatient corresponds to an axis measurement for an astigmatism, asindicated by block 114. It should be appreciated that the axismeasurement can be used as at least one part of a skew function whichthe system may apply to other diagrams and figures displayed for thefirst eye. In one embodiment, the system receives an input from apatient, wherein the input indicates that they do not have anastigmatism in the eye being tested, as indicated by block 120. In thisembodiment, the patient may either move on to blocks 122 through 130with their first eye, or they may repeat block 112 with their secondeye.

If the patient makes an input which indicates an axis measurement inaccordance with block 114, the system displays a second diagram on thecomputerized screen, as indicated by block 116. In one embodiment, thefirst diagram and second diagram are the same diagram. In anotherembodiment, the first diagram and the second diagram are differentdiagrams. In one embodiment, the second diagram is distorted based onthe partial skew from the axis measurement determined from the patient'sinput at block 114. For example, the second diagram may be stretched orelongated by some unit along the patient-identified axis. In anotherembodiment, the second diagram is not initially distorted.

The system receives at least one input from the patient, wherein the atleast one input corresponds to a cylinder measurement of the first eye,as indicated by block 118. It should be appreciated that the cylindermeasurement can be used as at least one part of a skew function whichthe system may apply to other diagrams and figures displayed for thefirst eye. The skew function is intended to correct for any astigmatismthat the patient may have in the eye being tested. As such, the skewfunction will make any diagram or figure it is applied appear distortedto a corrected eye, while appearing clear to a corrected eye.

It should be appreciated that blocks 112 through 120 should be repeated,separately, for the second eye of the patient. After repeating blocks112 through 120 for the second eye, it should further be appreciatedthat the axis measurement and cylinder measurement for the second eyecan be used as parts of a skew function which the system may apply toother diagrams and figures displayed for the second eye in the same waythose measurements were described as being used for the first eye. Itshould further be appreciated that, in one embodiment, immediately aftercompleting blocks 112 through 120 for a first eye, the patient mayswitch to their second eye and again work through blocks 112 through120. In an alternative embodiment, the patient may go on to otherblocks, for example, blocks 122 through 130, with their first eye,before returning to blocks 112 through 120 for their second eye.

At block 122, the system displays a first figure to the patient on thecomputerized screen intended for a first eye (either right or left) ofthe patient. The first figure is displayed such that it is too small tobe clearly seen by the patient. It should be appreciated that thepatient should view the first figure with their uncorrected first eye,i.e. if they wear glass or contacts, they should remove them and viewthe figure without the correction of their glasses or contacts. In oneexample embodiment, the first figure is distorted by the skew functiondetermined with the patient inputs of blocks 114 and 118 for thepatient's first eye. In another example embodiment, the first figure isnot distorted by the skew function.

The system receives an input from the patient regarding how they viewthe first figure with their first eye, wherein the input from thepatient corresponds to a first sphere measurement, as indicated by block124.

As indicated by block 126, the system displays a second figure on thecomputerized screen, wherein the second figure is displayed such that itis large enough to be clearly seen by the patient. In one embodiment,the first figure and second figure are the same figure. In anotherembodiment, the first figure and the second figure are differentfigures. In one embodiment, the second figure is distorted It should beappreciated that the patient should view the second figure with theiruncorrected first eye, i.e. if they wear glass or contacts, they shouldremove them and view the figure without the correction of their glassesor contacts. In one example embodiment, the second figure is distortedby the skew function determined with the patient inputs of blocks 114and 118 for the patient's first eye. In another example embodiment, thesecond figure is not distorted by the skew function.

The system receives an input from the patient regarding how they viewthe second figure with their first eye, wherein the input from thepatient corresponds to a second sphere measurement, as indicated byblock 126. The system averages the first and second sphere measurementsto determine a final sphere measurement, as indicated by block 130. Itshould be appreciated by one of skill in the art that the system candetermine a final measurement in any suitable manner, and it finalmeasurement need not be the product of an straight average. For example,the system may use only the last-input result, only the first-inputresult, some weighted average based on statistical variance from otherinputs, or the system may completely ignore inputs it considers to be ofsuch a great statistical variance from other inputs that it is likely tobe in error.

It should be appreciated that blocks 122 through 130 should be repeated,separately, for the second eye of the patient. It should further beappreciated that, in one embodiment, immediately after completing blocks122 through 130 for their first eye, the patient may switch to theirsecond eye and again work through blocks 112 through 130 for theirsecond eye. In an alternative embodiment, the patient may have alreadycompleted blocks 112 through 120 with their second eye.

It should further be appreciated that the system may repeat sets ofblocks 122 and 124 any number of times, in any order, and may alternatesets of blocks 122 and 124 with sets of blocks 126 and 128 any number oftimes. In one example embodiment, the system works through blocks 122through 128 for an eye of the patient, then repeats blocks 122 and 124again for the same eye before moving on to block 130. In this exampleembodiment, the three resultant sphere measurements are averaged todetermine the final sphere measurement at block 130. In another exampleembodiment, the system works through blocks 122 and 124, then repeatsblocks 122 and 124, then also works through blocks 126 and 128 twotimes. In this example embodiment, the four resultant spheremeasurements are averaged to determine the final sphere measurement atblock 130.

As indicated by block 132, the system displays on the computerizedscreen a query to the patient regarding whether they would like aglasses prescription, a contacts prescription, or both. At block 134,the system receives an input from the patient regarding their desiredprescription or prescriptions.

The system displays pricing information to the patient, andconventionally enables the patient to select a method of payment and toprovide payment information, as indicated by block 136. Enabling thepatient to select their method of payment and to provide paymentinformation may be accomplished via a fillable form, fillable fields, orsome other way, as is well-known in the art. The system receives atleast one input from the patient regarding their desired method ofpayment and their payment information, as indicated by block 138, andprovides the patient their requested and paid-for prescription orprescriptions, as indicated by block 140.

In one embodiment, before the patient receives their prescription, it issent to one or more doctors to sign off on the various determinedrefractive error measurements. For example, the system may send the axismeasurement to be signed off upon by one doctor, the cylindermeasurement to be signed off upon by another doctor, and the spheremeasurement to be signed off upon by a third doctor. In an alternativeexample, the system may send all three measurements to the same doctorfor sign off. It should be appreciated that any combination of doctorssigning off on any part of the prescription may be employed for anycombination of cost and time effectiveness considerations.

It should be appreciated that the system may enable the patient to makean input regarding how or where to send their selected prescriptionafter they have received it. In one embodiment, the system may send theprescription data to an optometrist's or opthalmologist's offices, acentral glasses and/or contacts fulfillment company, a glasses and/orcontacts retail location (physical or virtual), or the like. In afurther embodiment, the patient may select where to send theprescription by choosing from a list, a map, entering a name, or someother method.

In another embodiment, the system may enable a patient to browseeyeglass frames. In such an embodiment, the system may display an imageof the patient with mock eyeglass frames displayed over the top of thepatient's face, and may enable the patient to modify the appearance ofthe frames, for example, by changing the size, shape, color, material,texture, etc. of the mock frames. In another further embodiment, thesystem may determine a location for the mock lenses on the face of thepatient in any suitable manner, such as via known facial or pupilrecognition systems, or via a system-recognizable physical frameprovided to and worn by a user. In another further embodiment, thesystem may display instructions for a patient to purchase their desiredframes online, at a physical storefront location, or to have themshipped to a desired location.

It should be appreciated by one of skill in the art that the applicanthas surprisingly discovered, and disclosed herein, a novel inversion ofthe conventional method of determining the refractive error for apatient. In the conventional technique, the patient is located far froma figure or diagram, and lenses of various strengths and configurationsare placed before the patient's eyes. The patient provides subjectivefeedback on which of the lenses provides better vision quality. Thedoctor or technician refines the prescription by changing the lensesplaced in front of the patient's eyes, until the subjective feedbackfrom the patient indicates that the best vision quality has beenaccomplished by one of the provided lenses. In contrast, the embodimentsof the present disclosure do not require any lenses or any lensassembly. It should be appreciated that the diagrams and figuresthemselves are adjusted by the inputs of the patient, and thus thenecessary prescription may be determined, in whole or in part, fromfactors such as: the distance between the patient and the computerizedscreen, the original size of the diagram or figure on the computerizedscreen, the patient-adjusted size of the diagram or figure on thecomputerized screen, the number of inputs received from the patient, theamount of incremental effect of each input, and other relevant factors.

It should further be appreciated that, in some embodiments of thepresent disclosure, the patient may indicate to a second person whichinput should be made. In those embodiments, the second person wouldperform the input to the computerized screen, based on the instructionsof the patient. The second person may be any suitable person, includinga friend of the patient, family member of the patient, doctor, officeassistant, office technician, or any other person.

It also be appreciated that the present disclosure is not limited to asingle computerized screen. In some embodiments, the patient may usemore than one computerized screen, on one or more patient terminals, tointeract with the system. In another embodiment, the patient and thesecond person may interact with the system on the same patient terminaland/or computerized screen. In still another embodiment, the patient andthe second person may interact with the system on different patientterminals and/or computerized screens.

In another embodiment the system may allow a patient to begin theprocess and method in one location, such as a brick and mortar location,and continue or complete the process and method in at least one otherlocation, such as in their home. It should be appreciated that in suchan embodiment some kind of unique patient identification would be usedto authenticate that the same patient is interacting with the system inthe first location and the additional location(s). Such authenticationsystems are known in the art and described below.

In another embodiment, a patient may use one computerized screen tocontrol another computerized screen. For example, the system may enablea patient with a smartphone to use the smartphone as a remote to controlanother patient terminal with a computerized screen, such as a kiosk,personal computer, or tablet computer in order to interact with thesystem. In one example of such an embodiment, the system would send apatient a link to their remote device, such as via email or SMS textmessage. The patient is enabled to access the link to launch aninterface, such as via a browser, which can then be used to interactwith the system in a unique hand held manner. In another exampleembodiment, the remote device interacts with the system through anapplication stored on the remote device, commonly known as an “app.” Theremote device may be any suitable device, such as a cell phone, smartphone, tablet, notebook, or other remote device, that is capable ofinteracting nearly-instantaneously with the system to receiveinstructions and enable the patient to make at least one input to thesystem over at least one communication interface, such as the internet,text messaging, email, voice, or data, to control the computerizedscreen from a distance. It should be appreciated by one of skill in theart that such a system is unique in that it allows a patient to take amedical examination with their own smartphone or other remote device,and fully be able to control the examination.

In another embodiment, the system utilizes a handheld patient terminalwith a digital screen remote from a second patient terminal with adigital screen as a remote control for testing done via the internet byeffectively turning the handheld patient terminal into a remote controlvia a any suitable client or server application (such as a web browser).For example, the handheld patient terminal may be any suitable device,such as a cell phone, smart phone, tablet, notebook, or other remotedevice, that is capable of interacting nearly-instantaneously with thesystem to receive instructions and enable the patient to make at leastone input to the system over at least one communication interface, suchas the internet, text messaging, email, voice, or data, to control thecomputerized screen from a distance. The remote patient terminal maysimilarly be any suitable device with a computerized screen large enoughto be viewed from a distance, such as a kiosk, personal computer, ortablet computer in order to interact with the system.

In one example embodiment of such a system, the patient is enabled tolog into an online portal on either terminal, and make at least oneinput to request a message be sent to the handheld terminal. The messagemay be any suitable message, such as a text message, an email message,or a voice message. For example, the system may send the patient a textmessage to their smart phone after the patient requests the message byentering their cell phone number. The patient is enabled to click on orenter a link within the message, which will cause the system to open aweb browsing session on the handheld terminal, transforming the handheldterminal into a remote control for the remote terminal, which is alsologged into a browsing session. The system may connect the handheldterminal and the remote terminal sessions via any suitable protocol. Ina further embodiment, the system connects the handheld terminal and theremote terminal sessions via a Web Socket protocol. A Web Socketprotocal provides full-duplex communications channels over a single TCPconnection, and allows the server to send content to a browser withoutbeing queried by the client, and maintains the same connection whilemessages are sent back and forth. Such a direct line of duplexcommunication increases the real-time speed of a remote control, makingthe remote more convenient for a patient, and providing a better userexperience. Applicants have surprisingly found that the use of a remotecontrol and, more specifically, the use of a Web Socket-based remotecontrol of a smartphone, tablet, or other portable handheld device tocontrol a web accessible computer based system, such a PC, MAC, or anytablet with a digital screen in unique and advantageous in thetelemedicine space. The use of such a device, results in the ability tohave real time transmission, and real time feedback to a patient whenrunning a telemedicine based solution, which is more convenient for thepatient.

In another embodiment, the system uses a voice recognition system toenable a patient to make at least one input. In a further embodiment,the system includes a voice recognition system for conducting an eyeexamination, or a sub-examination of an eye examination. In a such anembodiment, the system would enable a user to make an input by speakingto the system, equipped with a microphone and conventional voicerecognition software. As is known in the art, microphones and voicerecognition software are readily commercially available and use standardvoice recognition formulas which embed a conventional automatic learningsystem, so that the system would be able to adapt to more difficultlanguages over time. The system would receive voice inputs from thepatient to record and analyze them using the conventional voicerecognition software. It should be appreciated by one of skill in theart that enabling a patient to provide inputs via their voice wouldprovide several benefits. First, the patient that is taking constituenttests of an examination, such as an eye examination, would not need tosee the details of the screen perfectly clearly, and could utilize theirhearing (communicated through spoken instructions) and speaking (toprovide inputs back to the system) instead, which is more user-friendlysince it is easier to use and provides additional options for inputtingresponses. This is especially relevant for portions of the system inwhich the patient is using an uncorrected eye, is somewhat distant fromthe computerized screen, or both. Another benefit of such a system isthat it enables a patient to use their hands for purposes other thanproviding inputs to the system. For example, the patient may then befree to hold up test object, or to cover their eyes. Further, the use ofa system which speaks to the patient and allows the patient to respondby speaking back simulates a more typical doctor's office-basedsubjective eye examination, and may help patient's assimilate to thesystem of the present disclosure.

Referring now to FIGS. 2A and 2B, an embodiment of the presentdisclosure is illustrated. The example system of FIG. 2A includes adisplay 200 which the system shows on the above-described computerizedscreen. The display 200 includes progress bar 202, 204, 206, and 208. Itshould be appreciated that the progress bar may be any suitable progressmeter. In the embodiment of FIG. 2A, the progress bar 202, 204, 206 and208 is a sectioned progress bar where the section currently being workedon 202 is indicated by being a darker color than the other sections. Itshould be appreciated that for a sectioned-type progress bar, or othertypes of progress meters, the indication of the section being worked oncan be any variation in color, size, font, text, or otherwise. Inanother embodiment, the sections of the progress bar are selectable bythe patient, such that the patient can move through the process 100 byselecting the section of the process to which they wish to go. In adifferent embodiment, the sections are not selectable by the patient tomove the patient through the various sections.

In the embodiment illustrated by FIGS. 2A and 2B, the system providesinstructions for the patient regarding how to work through the section202, and further provides verbal instructions which the patient cancontrol, turn off, turn on, and/or adjust by articulating the verbaldirection control elements 210.

As illustrated by the embodiment shown in FIGS. 2A and 2B, the systemqueries the patient regarding whether they have their prior glasses orcontacts prescription 212. The patient is enabled to respond to thequery by selecting one of the radio buttons 214 or 216. It should beappreciated that any other method for accepting a response to a queryfrom the patient may be employed by the system, such as a drop downlist, a fillable field, and/or a check box.

In the embodiment of FIG. 2A, when the patient selects the radio buttoncorresponding to “YES” 214, the system provides the fillable form 218through 264. The system enables the patient to upload a picture of aprior glasses prescription 218 and/or a prior contacts prescription 236.The system also enables the patient to enter their prior prescriptiondata into the conventional fillable fields 220 through 234 and 238through 264. Specifically, the fillable form has fields for the glassesprescription of the patient's right eye, or “OD” 220, 222, 224, and 226.“OD” is the common acronym for the latin “oculus dextrus,” which means“right eye.” The fillable form also has fields for the glassesprescription of the patient's left eye, or “OS” 228, 230, 232, and 234.“OS” is the common acronym for the latin “oculus sinister,” which means“left eye.” More specifically, fillable fields 220 and 228 are for thesphere, or “SPH,” or power measurement of the patient's right and lefteyes, respectively. The sphere measurement represents the degree ofnearsightedness or farsightedness of the patient. The unit of the spheremeasurement is the diopter. A plus sign “+” in front of the spheremeasurement indicates the amount of farsighedness of the patient, whilea negative sign “−” in front of the sphere measurement indicates theamount of nearsightedness of the patient. The more positive (forfarsighted people) or negative (for nearsighted people) the spheremeasurement is, the more severe the refractive error, and thus, the morepowerful the corrective lenses must be to correct for the error.

The cylinder, or “CYL” fields 222 and 230 for the right and left eye,respectively, and the axis fields 224 and 232, for their right and lefteye, respectively, indicate that the patient has an astigmatism in thecorresponding eye. If no astigmatism is present, the cylinder and axisfields are conventionally left blank. The cylinder measurement indicatesthe severity, in diopters, of the astigmatism in the patient's eye. Thebigger the cylinder measurement, the more severe the astigmatism of thepatient. The axis measurement is a number between 0° and 180°. The unitof the axis measurement is degrees. The axis measurement indicates theaxis along which the patient's vision is distorted due to theimperfections in the curvature of the cornea.

The combination of sphere, cylinder and axis measurements make up thedistance vision portion of the conventional eyeglasses or contactsprescription. The remainder of the glasses prescription is directed tothe near vision portion of the prescription, and is generally forreading glasses or the reading portion of bifocal corrective lenses. TheADD fields 226 and 234, respectively for the right and left eyes of thepatient, represent the additional refractive power, in diopters, to beadded to the spherical power in order to allow the patient to readup-close if they are presbyopic. If the patient needs no correction fordistance vision, the ADD power alone would be the patient's prescriptionfor conventional reading glasses, available at most drugstores and/orconvenience stores.

In an example embodiment, the system enables a patient to determine theADD power for those patients who require it. Those patients are referredto as presbyopic emmetropes (those that do not require spectaclecorrection for distance), and their presbyopia is generally a result ofaging, typically occurring around approximately 40 years old. This isthe age period when a patient generally begins to need reading glasses.However, in the past, in order to determine a correct reading glassesADD number, or to create a proper no-lined progressive bifocal spectacleor contact lens, patients needed to go to an eye doctor's office toobtain the proper measurment. Applicants have surprisingly found,however, a system for determining the power for both top and bottomportions of bifocal lenses which avoids the need to visit a doctor'soffice or endure a full and lengthy examination at the office. Thesystem queries the patient regarding their age, the size of figures theyare able to see with their uncorrected eyes (via any of the methods orprocesses disclosed herein), and the distance they desired to becorrected for (i.e. a patient may desire a single pair of glasses to seeboth books at 16 inches and to see other objects at 21 inches (or anyother combination of top segment and bottom segment)). It should beappreciated that the desired distances can be determined by any suitablemethod, such as via a computerized screen as disclosed herein (such as asmartphone), a simple printable paper measurement aid, via estimationwith a length of paper. The system may also enable a patient to estimatethe distance range they most desire to be corrected for, such as thedistance range they use most often, in easily estimable terms, such asarms length, further than arms length, or closer than arms length. Thesystem utilizes such inputs from the patient to determine a customprescription for no-line bifocals or single reading glasses withoutguessing or requiring a trip to a doctor's office and its associatedexpenses.

As shown in FIG. 2A, the contacts prescription includes many of the samemeasurement fields as the glasses prescription. Specifically, the spheremeasurement fields, 238 and 252; the cylinder measurement fields, 240and 254; the axis measurement fields, 242 and 256; and the addmeasurement fields, 244 and 258, for the right and left eyes,respectively, are also present in the contacts prescription. Althoughthe fields have the same names and abbreviations, contacts prescriptionsand glasses prescriptions can be different, partly because the lenses ofglasses are further from the surface of the eye than contacts.

In addition, the system provides the additional measurement fields forthe base curve, or “BC,” 246 and 260, the diameter, or “DIAM,” 248 and262, and the name of the contacts brand and/or manufacturer, 250 and264. During the time when only hard, gas permeable contact lenses wereavailable, the base curve and diameter measurements were necessary toensure the comfort of the rigid lenses. With the rise of soft, flexiblecontact lenses, many contact lens manufacturers only provide one, two,or a few different base curve or diameter options for their lenses. Ifthe base curve and diameter measurements are known from a priorprescription, and the patient was comfortable in those lenses, thenother lenses with those same measurements are highly likely to also becomfortable for the patient, even if the manufacturer is different. Ifthe manufacturer is the same, it is even more likely that the patientwill be comfortable in lenses with the same measurement. In this way, itshould be appreciated that a contacts “fitting” is generally unnecessaryfor those who have previously worn contacts, so long as the patient wascomfortable in their prior lenses. In one embodiment, forpatient-identified prior contacts manufacturers or brand names, the basecurve and diameter measurements can be looked up by the system in alookup table or other memory database. In another embodiment, the systemcan automatically fill in, or populate, any possible fields 246, 248,260, and/or 262 with the looked-up base curve and diameter measurements.

In an embodiment, the system can use the prior prescription informationas a check on the determined current prescription. In a furtherembodiment, the system can require more tests from a patient to confirmthe current prescription if there is a statistically significantdifference between a value of the prior prescription and thecorresponding value of the determined prescription.

In one embodiment, the system is capable of reading the uploaded pictureor scan of the prior glasses prescription 218 and/or the prior contactsprescription 236. In a further embodiment, the system may automaticallyfill in, or populate, any possible fillable fields with information readfrom the uploaded prior glasses prescription 218 and/or the priorcontacts prescription 236. In another embodiment, the patient may uploada photograph or scan of a prior contacts box or container and the systemmay automatically fill in, or populate, any possible fillable fieldswith information read from the uploaded photograph or scan of the priorcontacts box or container. In another embodiment, the system is capableof recognizing conventionally encoded information, such as informationfrom a barcode, QR code, matrix code, Aztec code, or other known typesof encoded information. In a further embodiment, the system is capableof scanning the encoded information from a prior glasses or contactsprescription, and/or a prior glasses or contacts box or container. In astill further embodiment, the system may automatically fill in, orpopulate, any possible fillable fields with information read from thescanned prior glasses or contacts prescription, and/or a prior glassesor contacts box or container.

After the patient fills in whatever data the patient has available fromprior prescriptions, the system queries the patient regarding whatappears more blurry or out of focus for them when they are not usingcorrective lenses 268. Again, in the example embodiment of FIG. 2A, thesystem provides radio buttons 270, 272, and 274 for the patient toselect an answer, but any suitable method for enabling an input to thequery would be acceptable. If the patient selects distance 270 as beingmore blurry, this may suggest that they are nearsighted, and they mayhave some astigmatism. If the patient selects near 272 as being moreblurry, this may suggest that they are farsighted, and they may havesome astigmatism. If the patient selects both as being equally blurry274, they may be nearsighted or farsighted, and they likely have anastigmatism.

As illustrated in the embodiment of FIG. 2B, when the patient respondsto the query regarding whether they have a prior prescription with “NO,”the system does not display the fillable form and fields 218 through264, as in FIG. 2A. Instead, in the embodiment of FIG. 2B, the systemmoves directly to a presentation of query 268 and enables the patient torespond via radio buttons 270, 272 and 274, just as in FIG. 2A.

Referring now to FIG. 3 , another embodiment of the present disclosureis illustrated. At this stage of the process, the system presentsdisplay 200, and the progress bar indicates that the patient iscurrently in the Astigmatism Angle section 204. The eye tracker 302, 304indicates which eye is being tested. It should be appreciated that theeye tracker may be any suitable progress meter. In the embodiment ofFIG. 3 , the eye tracker 302, 304 is a sectioned eye tracker where thesection corresponding to the eye being tested 302 is indicated by beinga darker color than the other section corresponding to the other eye. Itshould be appreciated that for a sectioned-type eye tracker, or othertypes of progress meters, the indication of the eye being tested can beany variation in color, size, font, text, or otherwise. In anotherexample embodiment, the sections of the eye tracker 302, 304 areselectable by the patient, such that the patient can change the eyebeing tested by selecting the section corresponding to the other eye. Ina different embodiment, the sections are not selectable by the patientto change the eye being tested.

As can be seen by reference to FIG. 3 , the eye tracker 302, 304indicates that the eye being tested is the left eye, indicated by thedarker shading of the left eye section 302. Written instructions 306 areprovided to the patient, along with verbal instructions, which thepatient can control with verbal direction control elements 210. In theexample embodiment shown in FIG. 3 , the written directions read “Coveryour right eye. Select the line that is darker, thicker or moreprominent. If three lines are darker, thicker or more prominent thenselect the middle. If two lines are darker, thicker or more prominentthen select the middle button between those lines.” The directions 306refer the patient to the diagram 310. Diagram 310 is a known diagram fordiagnosing the axis of an astigmatism. Patients with an astigmatism willsee the lines around the axis of their astigmatism as more bold, or inbetter focus, then the other lines of the diagram. The lines correspondto angle measurements. In this example embodiment, the lines are evenlyspaced at intervals of 15°. It should be appreciated that any suitableangular interval may be employed by the diagram 310. The system enablesthe patient to make an input of a line, or the centermost part of agroup of lines, which are more prominent when the patient views thediagram. It should be appreciated that the patient is viewing thediagram with their uncorrected eye.

In the embodiment shown in FIG. 3 , the letters A through S 308, as wellas the smaller letter combination buttons 310 are selectable to indicatethe axis angle of the patient. It should be appreciated that the axisline selectable icons 308, 310 need not be letters, but could benumbers, the angle measurement, pictures, symbols, or any other suitableicon. As shown in FIG. 3 , the letter “A” 308 a corresponds to an axisof 0°, the letter “G” 308 b corresponds to an axis of 75°, the letter“J” 308 c corresponds to an axis of 90°, the letter “O” 308 dcorresponds to an axis of 165°, and the letter S 308 e corresponds to anaxis of 180°. In another example embodiment, the system provides abutton for the patient to indicate that none of the lines in the diagramappears as darker, thicker or more prominent, indicating that thepatient does not have an astigmatism in that eye. In a further exampleembodiment, when the patient makes at least one input which indicatesthat they do not have an astigmatism in the eye being tested, the systemmoves on to test the other eye for an astigmatism. In anotherembodiment, when the patient makes at least one input which indicatesthat they do not have an astigmatism in the eye being tested, the systemmoves on to the eye test for that same eye, skipping the section testingthe astigmatism severity for that eye. In an alternative embodiment,when the patient makes at least one input which indicates that they donot have an astigmatism in the eye being tested, the system still teststhe severity of any astigmatism in that eye as a double-check that thepatient does not have an astigmatism in that eye.

It should be appreciated that, after selecting the line or lines of thepatient's axis measurement for the patient's left eye, as shown in FIG.3 , the system may repeat the same test with diagram 310 for the righteye by moving the eye tracker 302, 304 to indicate that the right eye304 is being tested, and by adjusting the written instructions 306 toreflect that the right eye is now being tested. In another embodiment,the patient continues to work through the sections of the progress barwith the left eye, and, after completing the astigmatism severity test206 for the left eye, will repeat the two astigmatism sections 204 and206 for the right eye before moving on to the eye test 208 for eithereye. In another embodiment, the patient works through all sections 204,206, and 208 with one eye, the left eye, for example, before going backto work through each section 204, 206, and 208 with the other eye, inthis example, the right eye. It should further be appreciated that anyorder of testing, with any order of eyes being tested is suitable. Itshould further be appreciated that by providing patient-selectableprogress bar sections 204, 206 and 208, and eye tracker sections 302 and304, the patient may select whichever order they prefer.

Referring now to the embodiment illustrated in FIG. 4A, another exampleembodiment of the present disclosure is illustrated. At this stage ofthe process, the system presents display 200, and the progress barindicates that the patient is currently in the Astigmatism Severitysection 206. The eye tracker 302, 304 indicates that the left eye 302 isbeing tested. The written directions 406 read: “Cover your right eye. 1.Keep Right Eye covered. 2. Click the (+) until the grid is all perfectsquares.” The written instructions refer to diagram 408 a, which shows alarge square divided into several smaller squares. The system providespatient-selectable icons 410 and 412 to adjust the diagram until thepatient views all of the grid of diagram 408 a as perfectly square. Whenthe patient views all of the grid of diagram 408 a as perfectly square,the patient selects the patient-selectable icon 414. If the system ismalfunctioning in some way, the system provides a button 418 to requestassistance with the malfunction. It should be appreciated that button418 is optional, but useful in the case that the animation of thediagram changing is not visible to the patient. It should further beappreciated that diagram 408 a in FIG. 4A is illustrated as it wouldappear to a patient without an astigmatism, or to a patient with anastigmatism who is wearing their corrective lens on the eye beingtested. In other words, the boxes of diagram 408 a are square in FIG.4A, but would appear distorted to an uncorrected eye with anastigmatism.

The applicant has surprisingly found that use of the grid shown asdiagram 408 a can be used to determine the cylinder prescription of apatient by measuring the amount of distortion is necessary, along thepatient's axis of astigmatism, in order for the patient to view thefigure as square to their uncorrected eye.

Referring now to the embodiments illustrated in FIG. 4B, 4C, 4D and 4E,other embodiments of the present disclosure are illustrated. In theembodiments of these figures, the patient has selected icons 308 a, 308b, 308 c, 308 d, and 308 e of FIG. 3 , respectively. Thus, thecorresponding diagrams of those FIGS. 408 b, 408 c, 408 d, and 408 e ,respectively, are illustrated as being stretched along thepatient-selected axis for that figure. Specifically, FIG. 4B shows thediagram 408 b distorted along the 75° axis, FIG. 4C shows the diagram408 c distorted along the 90° axis, FIG. 4D shows the diagram 408 ddistorted along the 165° axis, and FIG. 4E shows diagram 408 e distortedalong the 180° axis. If the patient selects the “+” 412, the diagramelongates along the axis. If the patient selects the “−” 410, thediagram contracts along the axis. In this way, the patient canmanipulate the diagram until the boxes appear square to theiruncorrected eye. As the patient manipulates the diagram, scale 416provides a visual representation to the patient of how much they havechanged the diagram 408 b, 408 c, 408 d, or 408 e.

It should be appreciated that the system may distort the diagram in anysuitable way, at any suitable speed, and at any suitable increment. Inone embodiment, the system automatically distorts the diagram prior toenabling the patient to make an input. In another embodiment, the systemautomatically begins distorting the diagram, and continues to distortthe diagram until the patient makes an input to stop the distortion. Ina further embodiment, the patient may further adjust the distortion ofthe diagram by making at least one input. In another further embodiment,the patient may not further adjust the distortion of the diagram bymaking any inputs. In another embodiment, the system does not distortthe diagram prior to receiving at least one input from the patient.

Referring now to the embodiment illustrated in FIG. 5 , anotherembodiment of the present disclosure is illustrated. As shown in FIG. 5, the patient has manipulated diagram 408 f such that, to the patient'suncorrected eye, the boxes appear square. Scale 416 demonstrates thatthe diagram 408 f has been manipulated. At this point, the patient canpress the icon 414 indicating that they view the boxes of the diagram408 f as square. The system determines, from the amount of manipulationof diagram 408 f, a cylinder measurement for that eye of the patient.

It should be appreciated that the combination of the axis measurementand the cylinder measurement for a given eye of the patient can be usedby the system to determine a skew function to apply to further diagramsand figures intended for the given eye. In this way, the astigmatismwill not affect the results of the eye test, for example, because thefigures used in the eye test will have been modified to counter theeffect of the astigmatism.

Referring now to the embodiment illustrated in FIG. 6 , another exampleembodiment of the present disclosure is illustrated. At this stage ofthe process, the system presents display 200, and the progress barindicates that the patient is currently in the Eye Test section 206.Specifically, the display 200 in FIG. 6 is directed to calibrating acamera which may be attached to the computerized screen to determine thedistance of the patient from the computerized screen. The system mustknow the distance of the patient in order to accurately calculate thesphere measurements from the eye tests. If the patient's computerizedscreen does not have a camera, the system will provide the patient aspecified distance to remain away from the screen. This distance may bethe same or different for each instance of the “small-to-large” eye test(described at blocks 122 and 124 of FIG. 1A) and/or each instance of the“large-to-small” eye test (described at blocks 126 and 128 of FIG. 1A).

The written instructions 606 of the example embodiment illustrated byFIG. 6 read: “1. Hold a credit card with the magnetic strip facing thecamera. 2. Place the card 11″ from the camera. 3. Use a piece of paperto measure 11″. Roll the paper the long way. Place one end touching thescreen near the camera and the other touching the credit card. Removethe paper and keep the card in place. Click the Calibrate button. 4.Click on the magnetic strip in the picture. 5. When magnetic strip ishighlighted click the Done button.” Camera viewer 610 shows the patientwhat the camera is viewing. The patient can follow the instructions toclick the Calibrate button 612 and the Done button 614 in accordancewith the written instructions. It should be appreciated that any othersuitable or conventional method of calibrating the distance between thepatient and the computerized screen may be employed.

It should be appreciated that any suitable distance between the patientand the screen may be used. In one embodiment, the distance between thepatient and the screen is determined based on whether the patient isnearsighted or farsighted. In a further embodiment, the systemdetermines that the distance between the patient and the screen is thesame for a nearsighted patient and a farsighted patient. In anotherembodiment, the system determines that the distances between the patientand the screen are different for a nearsighted patient and a farsightedpatient. In one embodiment, the system may determine the distancebetween the patient and the screen depending on the kind, type,dimensions, or other characteristics of the screen. In anotherembodiment, the patient may be enabled to make an input regardingwhether the determined input is difficult for the patient to use. In afurther embodiment, the system may determine a new distance between thepatient and the screen after the patient makes an input regardingwhether the determined input is difficult for the patient to use.

In another example embodiment, they system or patient terminal mayutilize mirrors to simulate the a greater or lesser distance between thepatient and the computerized screen, such as is conventional inprojection technology, or in, for example, a optometrist's office. In afurther example embodiment, the mirrors are adjustable based on thelocation of the patient, such that the patient may move and the mirrorsmay adjust to account for the movement to maintain the same simulateddistance.

In another example embodiment, the system determines a focal distancefor patient, which may then be used for various tests, such asastigmatism cylinder determination tests. As discussed in the Backgroundsection, astigmatism is a refractive error of the eye that causes lightentering the eye to focus on two points in or around the retina of apatient, rather than one. Patients with astigmatism may have any of thefollowing combinations of focal points for one or both eyes: in front ofthe retina and behind the retina; in front of the retina and on theretina; on the retina and behind the retina; two points in front of theretina separated by a finite distance; or two points behind the retinaseparated by a finite distance. These focal points in and around thepatient's retina correlate to distances in real space. Therefore, apatient with astigmatism can relocate themselves nearer to or furtherfrom an object until their view of that object is approximately infocus, despite the astigmatism. That location (where the viewed objectis approximately in focus) is the real space location corresponding toone of the patient's two focal distances.

Applicants have surprisingly found that, when patients that view digitalscreens containing images oriented at the patient's axis of astigmatismwhere the patient is located remote from the digital screen at one oftheir focal distances, this enables the system to isolate the refractiveerrors related to astigmatism from the refractive errors related tosphere, providing a more accurate cylinder determination than when at aknown, but non-focal distance, location from the digital screen.

In one such example embodiment, the system instructs the patient to moveaway from the digital screen until they cannot see the details of theobject, image, or figure displayed on the digital screen. The displayedobject, image, or figure may be displayed at any suitable orientation,such as at the patient's astigmatism axis as was previously determinedby the system or as was gleaned from a previous prescription of apatient. The system enables the patient to make an input indicating thatthey cannot see the displayed object, image, or figure, then instructsthe patient to move towards the screen in small increments until theycan just make out the details of the displayed object, image, or figure.By way of example only, if the displayed image is a capital letter “E,”the system may instruct the patient to move towards the screen in smallincrements until they can make out the direction in which the tines ofthe “E” are pointing (left, right, up, down, etc.). The system enables auser to make at least one input indicating that they can just make outthe details of the displayed object, image, or figure. The distance ofthe patient from the screen when they can just make out the details ofthe object, image, or figure is one of the patient's focal distances. Inthis example embodiment, the system conducts the remainder of thecylinder determination with the patient at this determined focaldistance locations.

In another embodiment, the system instructs the patient to move a known,fixed distance from the digital screen displaying the testing images forthe duration of certain of the tests described herein, such as theastigmatism cylinder tests, the astigmatism axis tests, or any othersuitable test. The known, fixed distance may be any suitable distance,so long as the distance is known, input by the patient, or calculable atsome time before, during, or after the patient undergoes the cylinderdetermination tests. In one example embodiment, the known, fixeddistance is 10 feet. In another example embodiment, the known, fixeddistance is 6 feet. In an example embodiment wherein the patient islocated a known, fixed distance from the digital screen displayingtesting images, the specific testing being conducted would proceed underthe direction of the system as described in detail elsewhere in thisdisclosure.

In an additional example embodiment, the system may query the patientfor their shoe size and gender and, using that information, have thepatient estimate their distance from the computerized screen viaheel-to-toe measurement and enter that distance into the system. In analternative example embodiment, the system may instruct the patient totake a determined number of heel-to-toe steps from the computerizedscreen, placing the patient at a fairly accurate distance from thecomputerized screen.

In another example embodiment, the system utilizes an input from anexternal source that can triangulate and measure the distance of anindividual in real time from that of a monitor, as is known in the art.Example systems include X-Box Kinect®, which has a distance monitoringfunction utilizing a depth sensor combining an infrared laser projectorand a monochrome CMOS sensor, which captures video data in 3D under anyambient light conditions. This external source input is then utilized,either in whole or in part, to measure the distance between the patientand the computerized screen, to perform a validation check of thedistance a patient believes he or she is at (input by the patient orbased on system instructions to the patient to move to a certaindistance), or to verify measurements in kiosk-based structures orsystems (as described further herein).

Referring now to the embodiment illustrated in FIG. 7A, anotherembodiment of the present disclosure is illustrated. At this stage ofthe process, the system presents display 200, and the progress barindicates that the patient is currently in the Eye Test section 206. Theeye tracker 302, 304 indicates that the left eye 302 is being tested.For systems with cameras, the system provides a calibration box 708 withan estimate of the distance of the patient from the camera/computerizedscreen. In one embodiment, the system uses the camera-measured distanceof the patient from the screen to determine a font size or an icon sizeto display to the patient as part of FIG. 710 .

The written instructions 706 read: “Cover your right eye. Move your face28 inches from the screen. Click “I can see” when you can just barelyrecognize the letters from that distance. DON'T WAIT UNTIL IT IS CLEAR!Use the + and − to make sure the letters are just barely recognizable.”The written instructions refer to FIG. 710 , which in this embodiment isa series of letters. It should be appreciated that any suitable kind ornumber of visual cues, symbols, shapes, or icons can make up the FIG.710 , such as letters, numbers, pictures, or the like. As shown in FIG.7A, the system provides patient-selectable icons 712 and 716 to adjustthe figure until the patient views the figure as just barely being ableto make out the letters of the figure. When the patient views the figureand can just barely make out the letters, the patient selects thepatient-selectable icon 414. In one embodiment, the FIG. 710 startssmall enough that the figures cannot be clearly seen by the patient, andthe patient must make at least one input to increase the size of thefigure until it can just barely be made out. In another embodiment,shown in FIG. 7B, the figure starts large enough to be clearly seen bythe patient, and the patient must make at least one input to decreasethe size of the figure just until the figure can no longer be made out.

The system determines a sphere measurement from at least one input froma “small-to-large” eye test. The system determines another spheremeasurement from at least one input of a “large-to-small” eye test. Asdiscussed previously, the “small-to-large” eye test and the“large-to-small” eye test may be performed any number of times, in anyorder, for each eye, with each eye test resulting in a spheremeasurement determined from the at least one input of the patient. Inone embodiment, the system may perform only the “small-to large” eyetest, and not the “large-to small” eye test. In another embodiment, thesystem may perform only the “large-to small” eye test, and not the“small-to large” eye test. Either or both eye tests may be performed oneor more times per eye of the patient. When the system has provided allinstances of the eye test to both eyes, the system averages the spheremeasurements from the eye test instances to determine a final spheremeasurement. It should be appreciated that the system may determine notto use a given sphere measurement in the final sphere measurement if itis a statistically significant unit of measurement away from the averageof the remaining resultant sphere measurements. In one embodiment, thesystem takes the mean of the resultant sphere measurements as the finalsphere measurement.

It should be appreciated that the system may adjust the size of thefigure in any suitable way, at any suitable speed, and at any suitableincrement. In one embodiment, the system automatically increases (forthe “small-to-large” test) or decreases (for the “large-to-small” test)the figure prior to enabling the patient to make an input. In anotherembodiment, the system automatically begins increasing or decreasing thefigure, and continues to increase or decrease the figure until thepatient makes an input to stop the increasing or decreasing. In afurther embodiment, the patient may further adjust the size of thefigure by making at least one input. In another further embodiment, thepatient may not further adjust the size of the figure by making anyinputs. In another embodiment, the system does not increase or decreasethe figure prior to receiving at least one input from the patient.

It should be appreciated that the above-described embodiments of thepresent disclosure may be implemented in accordance with or inconjunction with one or more of a variety of different types of systems,such as, but not limited to, those described below.

Referring now to FIGS. 8A, 8B, 8C and 8D, another embodiment of thepresent disclosure is illustrated, wherein the system displays at leastone colorblocked diagram 800 and enables a patient to make at least oneinput to select a more defined-appearing part of the diagram, whereinthe input corresponds to a determination that the patient is near or farsighted (if not wearing corrective lenses), over or under corrected (ifwearing corrective lenses), or otherwise. The colorblocked diagram 800may be presented once, twice, or more in a series, for each eye. Thecolorblocked diagram 800 may be the same or slightly different for eachpresentation to the patient. In the examples shown in FIGS. 8A, 8B, 8C,and 8D, the colorblocked diagrams 800 are slightly different.

The colorblocked diagram 800 has at least two parts, shown as part 802and part 804. In the embodiment shown in FIGS. 8A-D, parts 802 and 804are semicircles having a background color. In the examples shown inFIGS. 8A-D, part 802 has a brighter background color, while part 804 hasa duller background color. It should be appreciated by one of skill inthe art that any suitable brighter and duller colors, may be used as thebackground color of parts 802 and 804, respectively. In one embodiment,part 802 has a background from the green family of colors (including thevarious colors of green from dark to light, bright to dark, and mixedwith other colors, i.e. yellow-green or blue-green), while part 804 hasa background from the red family of colors (including the various colorsof red from dark to light, bright to dark, and mixed with other colors,i.e. purple-red or red-orange). In another embodiment, part 802 has abackground from the yellow family, while part 804 has a background fromthe purple family.

Parts 802 and 804 further include a plurality of lines of variouslengths 806 that, when placed closed together and viewed from a shortdistance, appear as an arrowhead shape. In each of FIGS. 8A-D, the arrowdirections face away from each other, and are comprised of horizontal orvertical lines 806. It should be appreciated by one of skill in the artthat any suitable number of lines (straight or curved, in any suitabledensity), arranged into any suitable direction, making up any suitableaggregate shape may be used. In another further embodiment, the lengths806 may be replaced by solid or semi-solid shapes, such as circles,squares, triangles, letters, numbers etc. It should further beappreciated that parts 802 and 804 may be shapes other than semicircles,such as half squares, half triangles, etc.

As discussed above, the colorblocked diagram 800, in one or more of itsconfigurations, may be used to determine whether a patient is near orfar sighted if not wearing corrective lenses. The system may instructthe patient to remove any corrective lenses, such as glasses orcontacts, before using the system. The system presents a colorblockeddiagram to one eye of the patient, and enables the patient to make aninput regarding which of the arrow parts appears more distinct to theiruncorrected eye. In one embodiment, the patient may select that part 802with the brighter background looks more distinct (i.e. sharper or moredefined), that part 804 with the duller background looks more distinct,or that the arrows on parts 802 and 804 are about equally distinct. Ingeneral, a selection that part 802 with the brighter background is moredistinct than part 804 with the duller background suggests that thepatient is farsighted. In general, a selection that part 804 with theduller background is more distinct than part 802 with the brighterbackground suggests that the patient is nearsighted. It should beappreciated by one of skill in the art that performing two or more testsper eye with colorblocked diagrams having arrows pointing in differentdirections will assist in mitigating any subjective error from thepatient. In an embodiment, the patient is presented with FIGS. 8A to 8Din any order, for their first eye, than 8A to 8D, in any order, fortheir second eye. The system uses the results of the one, two, three,four, or more colorblocked diagram tests to determine the near or farsightedness of the patient.

It should be appreciated that the tests shown by example in FIGS. 8A to8D may also be used to determine if a patient is over or under correctedif performed while wearing corrective lenses. In one example embodiment,the patient performs the same steps described immediately above,individually for each eye, while using their corrective lenses. In thisexample embodiment, a selection that part 802 with the brighterbackground is more distinct than part 804 with the duller backgroundsuggests that the patient is overcorrected with their present correctivelenses, while a selection that part 804 with the duller background ismore distinct than part 802 with the brighter background suggests thatthe patient is under corrected by their present corrective lenses.

Referring now to FIG. 9A, another embodiment of the present disclosureis illustrated. FIG. 9A is a screen shot of an example of an embodimentof the system of the present disclosure, wherein the system displays aline diagram 900 and enables a patient to make at least one input toaffect the rotation of the line diagram, wherein the at least one inputcorresponds to an axis measurement. In the example embodiment shown inFIG. 9A, the line diagram 900 is a line, or a long thin rectangle on asolid background. The rectangle/line is made up of alternating parts 902and 904. Alternating parts 902 and 904 are different colors. In theembodiment of FIG. 9A, part 902 has a brighter background color, whilepart 904 has a duller background color. It should be appreciated by oneof skill in the art that any suitable brighter and duller colors, may beused as the background color of parts 902 and 904, respectively. In oneembodiment, part 902 has a background from the green family of colors(including the various colors of green from dark to light, bright todark, and mixed with other colors, i.e. yellow-green or blue-green),while part 904 has a background from the red family of colors (includingthe various colors of red from dark to light, bright to dark, and mixedwith other colors, i.e. purple-red or red-orange). In anotherembodiment, part 902 has a background from the yellow family, while part904 has a background from the purple family.

The alternating parts 902 and 904 may be any suitable shape or size. Forexample, in FIG. 9A, the alternating parts 902 and 904 are squares whichmake up the rectangle/line of line diagram 900, without any spacebetween the parts. It should be appreciated by one of skill in the artthat two or more alternating parts may be used.

The system presents the line diagram 900 to the patient. In oneembodiment, the system begins rotating the diagram 900 about its center.In another embodiment, the patient makes an input to begin rotation ofthe diagram 900 about its center. The rotation is slow enough that thepatient can identify changes. In one embodiment, the patient may make aninput to speed up or slow down the rotation of the diagram 900. Inanother embodiment, the diagram 900 does not rotate automatically, andthe patient must make an input corresponding to each rotation of thediagram 900.

The applicant has surprisingly found that use of a line diagram, such asline diagram 900, can be used to determine the axis prescription of apatient to within 1° of accuracy. Because the effect of an astigmatismis to distort, or stretch, a patient's vision along an axis, when theline diagram 900 is near or at the patient's axis of astigmatism, thealternating parts 902 and 904 will blur together and appear as adifferent color than either of the parts individually. In one exampleembodiment where part 902 is green and part 904 is red, the line appearsyellow at or near the axis of the patient's astigmatism. It should beappreciated by one of skill in the art that if the patient does not havean astigmatism, the line will not appear to change color.

The rotational axis of the line diagram 900 is composed of anglesranging from 0 degrees to 360 degrees. However, in an opticalprescription, angles are written in 0 degrees to 180 degrees. Thus, oneof skill in the art will appreciated that angles 0° and 180° are thesame, 170° and 350° are the same, 100° and 280° are the same and so onand so forth. The axis line extends below the 180° point, and that iswhy angles above 180° also have a corresponding equivalence below 180°.

In an embodiment of they system of the present disclosure, the systempresents the patient with the line diagram 900, which may rotate bysystem or patient direction, as described above. The patient viewing thediagram with one corrected eye at a time, is enabled to make an inputcorresponding to when they see the line appear to change color. In oneembodiment, the patient is prevented from making an input that the linedid not change color until at least one or more full rotations of theline have been completed. In another embodiment, once a patient makes aninput indicating that the line appeared to change color, the patient isenabled to make further fine-tuning inputs causing small rotations tothe line until the patient makes another input corresponding to theangle at which the changed color appears most distinctly (i.e.strongest, darkest, or most clear). In one embodiment, the fine-tuninginputs cause a rotation of 1°. It should be appreciated by one of skillin the art that other fine-tuning increments can be used, such as 2°,5°, or 10°. Since conventional subjective axis determination techniquesuse increments of 10°, and since an astigmatism can be along any axis(at any degree), any increment less than 10° should yield a moreaccurate determination than the phoropter system used by eye careprofessionals in-office. The angle selected by the input correspondingto the angle at which the changed color appears most distinctly is theaxis prescription of the patient. The system then repeats the processfor the other uncorrected eye of the patient.

In an embodiment, the system enables the patient to make an inputreflecting that the line did not appear to change color. It should beappreciated by one of skill in the art that such an input would suggestthat the patient does not have an astigmatism in that eye. In a furtherembodiment, the system gives the patient an additional axis test forthat eye, such as that described in FIG. 3 . In a different furtherembodiment, the system permits the patient to skip the cylinder test,and go right to an axis test for the other eye, or another kind of test,such as the power test.

Referring now to FIG. 9B, another embodiment of the present disclosureis illustrated. FIG. 9B is a screen shot of an example of an embodimentof the system of the present disclosure, wherein the system displays aline diagram 906 and enables a patient to make at least one input toaffect the spacing or size of various parts of the line diagram 906,wherein the at least one input corresponds to an cylinder measurement.

The applicant has surprisingly found that use of a line diagram, such asline diagram 906, can be used to accurately determine the cylinderprescription of a patient. Because the effect of an astigmatism is todistort, or stretch, a patient's vision along an axis, when thealternating parts are stretched to correspond to the severity of thepatient's astigmatism, the patient's eye will once again be able toresolve the alternating parts in their actual colors. It should beappreciated by one of skill in the art that if the patient does not havean astigmatism, the line will only appear with the alternating parts intheir actual colors.

The line diagram 906 shown in the example embodiment of FIG. 9B isdifferent from FIG. 9A in that it is used to determine the severity ofastigmatism for a patient. If it was previously determined that thepatient has an axis of astigmatism, this is the next test to determinehow much astigmatism that individual has. Line diagram 906 is firstshown in the angle of astigmatism that was determined in the axisdetermination test described with reference to FIG. 9A, and hasalternating parts 902 and 904, similar to those described above withreference to FIG. 9A. As confirmed previously during the test describedwith reference to FIG. 9A, the line diagram 906 should appear as adifferent color than the alternating parts 902 and 904. In the examplewhere alternating parts 902 and 904 are green and red, respectively, theline diagram 906 at the axis of astigmatism for the patient being testedshould appear yellow to the patient.

The system presents the line diagram 906 to one uncorrected eye of apatient at a time. In one embodiment, the system automatically increasesthe size (i.e. length and/or width) of the alternating parts 902 and 904until the patient makes an input indicating that they can see the colorsof the alternating parts again. The patient is enabled to makefine-tuning inputs to change the size of the alternating parts until thesize where they can first see the alternating colors. In an embodimentwhere line diagram 906 first appears yellow to a patient even thoughparts 902 and 904 are green and red, respectively, the patient wouldmake an input when they begin to see the green and red parts 902 and 904again. In another embodiment, the system does not automatically changethe size of the alternating parts, and enables the patient to makeinputs corresponding to all size changes.

In another embodiment, the system begins by inserting space between thealternating parts 902 and 904 until the patient makes an inputindicating that they can see the colors of the alternating parts again.The patient is enabled to make fine-tuning inputs to change the spacingof the alternating parts until the size where they can first see thealternating colors. In another embodiment, the system does notautomatically change the spacing of the alternating parts, and enablesthe patient to make inputs corresponding to all spacing changes.

It should be appreciated by one of skill in the art that the size andspacing changes can be made in the same test, at the same time, orsequentially in any order. In one example embodiment, the size of thealternating parts 902 and 904 changes until the patient make an input,at which point the system enables the patient to make fine-tuning inputsaffecting the size, spacing, or both of the alternating parts. Inanother example embodiment, the spacing of the alternating parts 902 and904 changes until the patient make an input, at which point the systemenables the patient to make fine-tuning inputs affecting the spacing,size, or both of the alternating parts. The system determines theastigmatism severity, or cylinder prescription of the patient from thefinal size and/or spacing of the alternating parts. The system thenrepeats the process for the other uncorrected eye of the patient.

Referring now to FIGS. 10A and 10B, another embodiment of the presentdisclosure is illustrated. FIG. 10A is a screen shot of an example of anembodiment of the system of the present disclosure, wherein the systemdisplays a line diagram 1101 and enables a patient to make at least oneinput, wherein the at least one input corresponds to a cylindermeasurement. FIG. 10B is a screen shot of an example of an embodiment ofthe system of the present disclosure wherein the FIG. 10A is rotatableto align with the determined axis of a patient's astigmatism.

In the example embodiment shown in FIGS. 10A and 10B, the line diagram1001/1004 is a series of lines, or long thin rectangles on a solidbackground. The series of lines includes lines of different sizes. Inthe example embodiment shown in FIG. 10A, the lines increase in size asthey are view from the top of diagram 1001 to the bottom of diagram1001. The rectangles/lines are made up of alternating parts 1002 and1003. Alternating parts 1002 and 1003 are different colors, one brighterand the other duller, similar to the alternating parts 902 and 904discussed above. In the embodiment of FIG. 10A, part 1003 has a brighterbackground color, while part 1002 has a duller background color.

It should be appreciated by one of skill in the art that the size of thelines or alternating parts, and the spacing between the lines or thealternating parts may be any suitable amount. For example, FIGS. 10A and10B show the lines separated by space, but the alternating parts of eachline are immediately adjacent. In another example embodiment, thealternating parts may have space between them and the lines may beimmediately adjacent.

The system presents the line diagram 1001 or 1104 to one uncorrected eyeof a patient at a time. The patient is enabled to make at least oneinput to select one or more lines that appear different in color fromthe remaining lines. In one example embodiment where part 1003 is greenand part 1002 is red, a line of alternating parts appears yellow belowthe cylinder, or astigmatism severity of the patient's astigmatism. Theselection may be accomplished in any suitable manner, such as byselecting and clicking a line, or a button representing a line, such asbuttons 1000.

The applicant has surprisingly found that use of a line diagram, such asline diagrams 1001 and 1004, can be used to accurately determine thecylinder prescription of a patient. Because the effect of an astigmatismis to distort, or stretch, a patient's vision along an axis, when thealternating parts are stretched to correspond to the severity of thepatient's astigmatism, the patient's eye will once again be able toresolve the alternating parts in their actual colors. It should beappreciated by one of skill in the art that if the patient does not havean astigmatism, the lines will only appear with the alternating parts intheir actual colors.

Referring now to FIG. 11B, another embodiment of the present disclosureis illustrated. FIG. 11B is a screen shot of an example of an embodimentof the system of the present disclosure, wherein the system displays aconcentric semi-circle diagram 1105 and enables a patient to make atleast one input, wherein the at least one input corresponds to an axisand/or a cylinder measurement.

In the example embodiment shown in FIG. 11B, the semi-circle diagram1105 is a half-circle on a solid background. The half-circle is made upof alternating parts 1107 and 1108, arranged into concentrichalf-circles. Alternating parts 1107 and 1108 are different colors, onebrighter and the other duller, similar to the alternating parts 902 and904 discussed above. In the embodiment of FIG. 11B, part 1108 has abrighter background color, while part 1107 has a duller backgroundcolor.

The alternating parts 1107 and 1108 may be any suitable shape or size,with any suitable spacing between them. For example, in FIG. 11B, thealternating parts 1107 and 1108 are concentric curved rectangular sliceswhich make up the semi-circle of diagram 1105, without any space betweenthe parts. It should be appreciated by one of skill in the art that twoor more alternating parts may be used. In the example embodiment of FIG.11B, the semi-circle diagram 1105 is divided into wedges by radii lines1009. It should be appreciated that radii lines can be placed at anysuitable angular distance from each other, such as at 1, 2, 5, 10, or 30degrees, or at other degree increments. It is preferable that theangular distance be evenly divisible into 180 degrees. As shown in FIG.11B, the radii lines 1009 are placed 20 degrees apart.

The system presents the semi-circle diagram 1105 to one uncorrected eyeof a patient at a time. The patient is enabled to make at least oneinput to select one or more wedges that looks different in color fromthe remaining wedges. The selection may be accomplished in any suitablemanner, such as by selecting and clicking a wedge, or a buttonrepresenting a wedge, such as buttons 1106.

The applicant has surprisingly found that use of a semi-circle diagram,such as semi-circle diagram 1105, can be used to determine the axisprescription of a patient. Because the effect of an astigmatism is todistort, or stretch, a patient's vision along an axis, at the portion ofthe semi-circle diagram nearby to the patient's axis of astigmatism, thealternating parts 1107 and 1108 will blur together and appear as adifferent color than either of the parts individually. In one exampleembodiment where part 1108 is green and part 1107 is red, a portion of awedge appears yellow at or near the axis of the patient's astigmatism.It should be appreciated by one of skill I the art that a greaterblurring of the colors away from the center of the circle diagram,indicates a more severe astigmatism cylinder measurement. It should beappreciated by one of skill in the art that if the patient does not havean astigmatism, none of the portions of the wedges will appear to changecolor.

Referring now to FIG. 12B, another embodiment of the present disclosureis illustrated. FIG. 12B is a screen shot of an example of an embodimentof the system of the present disclosure, wherein the system displays aspoke diagram 1205 and enables a patient to make at least one input,wherein the at least one input corresponds to a gross axis measurement.

In the example embodiment shown in FIG. 12B, the spoke diagram 1205 is aseries of lines, or long thin rectangles on a solid background, arrangedas radii lines on a half-circle dark background 1209. In the exampleembodiment shown in FIG. 12B, the lines are approximately the same size.The rectangles/lines are made up of alternating parts 1207 and 1208.Alternating parts 1207 and 1208 are different colors, one brighter andthe other duller, similar to the alternating parts 902 and 904 discussedabove. In the embodiment of FIG. 12B, part 1207 has a brighterbackground color, while part 1208 has a duller background color.

The system presents the spoke diagram 1205 to one uncorrected eye of apatient at a time. The patient is enabled to make at least one input toselect one or more lines that appear different in color from theremaining lines. In one example embodiment where part 1207 is green andpart 1208 is red, a line of alternating parts appears yellow at or nearthe axis of the patient's astigmatism. The selection may be accomplishedin any suitable manner, such as by selecting and clicking a line, or abutton representing a line, such as buttons 1206.

Referring now to FIG. 11A, another embodiment of the present disclosureis illustrated. FIG. 11A is a screen shot of an example of an embodimentof the system of the present disclosure, wherein the system displaysfine spoke diagram 1002, which is a smaller angular portion of spokediagram 1205, and enables a patient to make at least one input, whereinthe at least one input corresponds to a fine axis measurement.

In the example embodiment shown in FIG. 11A, the spoke diagram 1102 is aseries of lines, or long thin rectangles on a solid background, arrangedas radii lines on a portion of a half-circle dark background. In theexample embodiment shown in FIG. 11A, the lines are approximately thesame size. The rectangles/lines are made up of alternating parts 1103and 1104. Alternating parts 1103 and 1104 are different colors, onebrighter and the other duller, similar to the alternating parts 902 and904 discussed above. In the embodiment of FIG. 11A, part 1104 has abrighter background color, while part 1103 has a duller backgroundcolor.

The system presents the spoke diagram 1102 to one uncorrected eye of apatient at a time. The patient is enabled to make at least one input toselect one or more lines that appear different in color from theremaining lines. In one example embodiment where part 1104 is green andpart 1103 is red, a line of alternating parts appears yellow at or nearthe axis of the patient's astigmatism. The selection may be accomplishedin any suitable manner, such as by selecting and clicking a line, or abutton representing a line, such as buttons 1101. It should beappreciated by one of skill in the art that the fine spoke diagram 1102represents the portion of the gross spoke diagram 1205 which the patientpreviously selected as appearing different in color from the otherportions of the diagram. It should further be appreciated that finespoke diagram 1102 uses smaller angular increments between the radiilines to provide a more accurate angular axis determination. In anotherexample embodiment, the patient may first select a wedge from thesemi-circle diagram 1105, then use the fine axis diagram 1102 to finetune the axis determination. In such example, the angular portion usedin diagram 1102 would correspond to the wedge section or sectionsselected by the patient as appearing different from the remainder of thewedges in 1105.

The applicant has surprisingly found that use of a spoke diagram, suchas spoke diagrams 1102 and 1205, can be used to accurately determine theaxis prescription of a patient. Because the effect of an astigmatism isto distort, or stretch, a patient's vision along an axis, at the portionof the spoke diagram nearby to the patient's axis of astigmatism, thealternating parts 1103 and 1104 of diagram 1102, and parts 1207 and 1208of diagram 1205 will blur together and appear as a different color thaneither of the parts individually. It should be appreciated by one ofskill in the art that if the patient does not have an astigmatism, noneof the lines will appear to change color. It will further be appreciatedthat any suitable sizing, spacing or shape of alternating parts may beused so long as they are along the various axes.

Referring now to FIG. 12A, another embodiment of the present disclosureis illustrated. FIG. 12A is a screen shot of an example of an embodimentof the system of the present disclosure, wherein the system displaysline diagram 1201, and enables a patient to make at least two inputs,wherein the at least two inputs correspond to a cylinder measurement.

In the example embodiment shown in FIG. 12A, the line diagram 1201 is aline, or a long thin rectangle on a solid dark background. Therectangle/line is made up of alternating parts 1202 and 1203.Alternating parts 1202 and 1203 are different colors, one brighter andthe other duller, similar to the alternating parts 902 and 904 discussedabove. In the embodiment of FIG. 12A, part 1202 has a brighterbackground color, while part 1203 has a duller background color.

The applicant has surprisingly found that when a patient withastigmatism views a diagram like 1201, they will see a doubled-line, ortwo lines, instead of the single line presented in the diagram. Theapplicant has further surprisingly found that the amount of distancebetween the two appearing lines corresponds to the cylinder measurementof the patient. It should be appreciated that a patient without anastigmatism will only see the single line.

The system displays the line diagram 1201 to one uncorrected eye of apatient at a time. The patient is enabled to make at least two inputs toselect the edge of a first appearing line and to select the edge of thesecond appearing line, as shown by arrows 1200 and 1204 in FIG. 12A. Inthis way, the patient is identifying the distance between the twoappearing lines. The patient is also enabled to select that they onlysee one line, indicating that they do not have an astigmatism, or thatthe size of the alternating parts is above their cylinder axis. In suchan example, the system may re-present the diagram 1201 with smalleralternating parts. The selection of beginning and ending points of thetwo-appearing lines may be accomplished in any suitable manner.

Referring now to FIG. 13 , another embodiment of the present disclosureis illustrated. FIG. 13 is a screen shot of an example of an embodimentof the system of the present disclosure, wherein the system displaysline diagram 1304, and enables a patient to make at least one input,wherein the at least one input corresponds to a cylinder measurement.

In the example embodiment shown in FIG. 13 , the line diagram 1304 is aline, or a long thin rectangle on a solid background, wherein the widthand height of the line increases when viewed from left to right. Therectangle/line is made up of alternating parts 1301 and 1302.Alternating parts 1301 and 1302 are different colors, one brighter andthe other duller, similar to the alternating parts 902 and 904 discussedabove. In the embodiment of FIG. 13 , part 1302 has a brighterbackground color, while part 1301 has a duller background color. Itshould be appreciated that any suitable arrangement of differently sizedlines is appropriate. For example, the width and height of the line maydecrease from left to right, or the line may be oriented vertically (orat any angle relative to horizontal) as opposed to horizontally. Inanother example, there may be space between the differently sized linesegments. In the example embodiment shown in FIG. 13 , there is no spacebetween the differently sized line segments.

The system displays the line diagram 1304 to one uncorrected eye of apatient at a time. The patient is enabled to make at least one input toselect one or more line segments that appear different in color from theremaining lines. In one example embodiment where part 1302 is green andpart 1301 is red, a line segment of alternating parts appears yellowbelow the cylinder, or astigmatism severity of the patient'sastigmatism. The selection may be accomplished in any suitable manner,such as by selecting and clicking a line segment, or a buttonrepresenting a line segement, such as buttons 1303.

The applicant has surprisingly found that use of a line diagram, such asline diagram 1304, can be used to accurately determine the cylinderprescription of a patient. Because the effect of an astigmatism is todistort, or stretch, a patient's vision along an axis, when thealternating parts are stretched to correspond to the severity of thepatient's astigmatism, the patient's eye will once again be able toresolve the alternating parts in their actual colors. It should beappreciated by one of skill in the art that if the patient does not havean astigmatism, the lines will only appear with the alternating parts intheir actual colors.

Referring now to FIGS. 14A-D, other embodiments of the presentdisclosure are illustrated. FIGS. 14A-D are screen shots of exampleembodiments of the system of the present disclosure which demonstratethat the alternating parts may be of different sizes or spacing, butstill test for the same determination in the astigmatism severitydetermination. From FIG. 14A to FIG. 14D, the spacing between thealternating parts increases. However, so long as the sizing and spacingis known, each of FIGS. 14A to 14D are usable by the system.

Referring now to FIG. 15 , another embodiment of the present disclosureis illustrated. FIG. 15 is a screen shot of an example of an embodimentof the system of the present disclosure, which demonstrates that thealternating parts may be of different sizes or spacing, but still testfor the same astigmatism axis determination. Contrast, for example, FIG.12B with FIG. 15 , which has larger alternating parts. However, so longas the sizing and spacing is known, each of FIGS. 12B and FIG. 15 areusable by the system.

Referring now to FIG. 16 , another embodiment of the present disclosureis illustrated. FIG. 16 is a screen shot of an example of an embodimentof the system of the present disclosure, which demonstrates that anastigmatism axis gross determination figure may be modified in size andshape, and stretched in minor fashion, and still be usable by the systemfor determining an axis of astigmatism for a patient. For example, FIG.16 shows a slight horizontal stretch as compared to the perfectlysemicircular figure of FIG. 11B. FIG. 16 also shows, in contrast to FIG.11B, smaller alternating parts and a greater number of wedges of thefigure which do not meet at a center point of the semicircular figure.

In another example embodiment, the system may test or confirm apatient's astigmatism axis by displaying only certain axes. For example,the system may display a set of shapes (such as circles) filled withlines of alternating colors (bright and dull), as described above. Inthis example embodiment, all of the lines in a given circle would be ofthe same axis, and the lines in the remaining circles could be at otheraxes. The system would enable the patient to make at least one input toselect a circle that appears blurry to each of their uncorrected eyes,tested individually. For instance, in the case where the bright color isselected from the green family and the dull color is selected from thered family, the patient may select the circle that appears yellow. Basedon the at least one input from the patient, the system can determine orconfirm the patient's axis prescription. For example, in a situationwhere the test is being given to confirm a prescription, the system willdetermine if the prescription is confirmed by comparing the axis of thepatient's selected circle or circles to the axis it previouslydetermined. If the axis measurements match or are close, then theprescription is confirmed. It should be appreciated that any suitablenumber of shapes, any suitable number of axes, and any suitable numberof iterations of the test may be utilized by the system to initiallytest or to confirm an axis prescription for a patient.

In another embodiment, the system begins the axis tests by displaying anobject(s), image(s), or figure(s) that appears most clearly (when viewedwith each uncorrected eye of a patient at a time) for those patientswith a 90 degree or 180 degree astigmatism axis. As is known in the art,the most common astigmatism orientations are at 90 degrees or 180degrees. This is caused by the cornea of a patient's eye not beinground, like a softball, but instead more flattened around the edges,like a football shape. The most common corneal surface shapes arehorizontal and vertical, yielding the 90 degree or 180 degree axis ofastigmatism (sometimes called “regular astigmatism”). Astigmatism errorsin other axes (sometimes called “irregular astigmatism”) are lesscommon, thus, from a time management perspective, it is best to startfrom the most common axes, and test the less common axes only when thepatient's input(s) indicate that they do not have an astigmatism axis of90 degrees or 180 degrees. Starting from the most likely axes will speedup the testing process, which is more convenient for the patient.

In such an example embodiment, the system displays object(s), image(s),or figure(s) that will appear sharper for patient's with a 90 degreeastigmatism (when viewed with each uncorrected eye of a patient at atime), contrasted with object(s), image(s), or figure(s) that do notappear as sharp for those patients. In a further example embodiment, thecontrasting object(s), image(s), or figure(s) are displayed at a 180degree axis thereby testing for the 90 degree or 180 degree astigmatismaxis together, which may save time and be more convenient for thepatient. In another example embodiment, multiple iterations ofobject(s), image(s), or figure(s) may be displayed, where the firstdisplayed set includes, for example, a 90 degree axis portion and otheraxes portions, and a second set may include a 180 degree axis portionand other axes portions. In a further example embodiment, if thepatient's input(s) indicate that they do not have an astigmatism axis of90 degrees or 180 degrees, the system will test for an axis in the 45and 135 degree angles in the manner described above, or herein. If thepatient's inputs still do not indicate that they have an astigmatismaxis of 45 or 135 degrees, the system may continue testing other axisoptions in the manner described in this paragraph or elsewhere in thisdisclosure. In a still further example embodiment, if the patient'sinputs still do not indicate that they have an astigmatism axis of 45 or135 degrees the system will estimate a determination that the patientdoes not have an astigmatism and move on to another portion of theexamination.

In another example embodiment, the system may test or confirm apatient's cylinder prescription by displaying spaced-apart shapes.Applicant has surprisingly found that spaced-apart shapes located alongthe patient's axis of astigmatism and spaced correspondingly to thecylinder of the patient (or higher) will appear to touch when viewedwith the patient's uncorrected eye (each eye individually). For example,the system may display two or more dots in a grid or any other suitablepattern, where at least two of the dots we spaced along the patient'saxis of astigmatism. The system would enable the patient to make atleast one input to select or otherwise identify the dots that appear toeach of their uncorrected eyes, tested individually, to be touching.Based on the at least one input from the patient, the system candetermine or confirm the patient's cylinder prescription, where theactual distance between the dots that appear to the uncorrected eye ofthe patient to be touching corresponds to a cylinder measurement. Forexample, in a situation where the test is being given to confirm aprescription, the system will determine if the prescription is confirmedby comparing the cylinder of the patient's selected dots to the cylinderit previously determined. If the cylinder measurements match or areclose, then the prescription is confirmed. It should be appreciated thatany suitable number of shapes, any suitable number of axes, any suitablecolors, and any suitable number of iterations of the test may beutilized by the system to initially test or to confirm a cylinderprescription for a patient. It should further be appreciated that thespaced apart shapes may be spaced at different intervals, or that morethan one display (with varying intervals between the shapes) may be usedin order to fine tune the cylinder determination.

In a further example embodiment where the system tests or confirms apatient's cylinder prescription by displaying spaced-apart shapes, thesystem may display a single shape (i.e., a triangle) split into multiplepieces, or multiple shapes, where the pieces/shapes are displayed asseparated from each other with blank space along the patient'salready-determined or known axis of astigmatism. In one example, thesespaced apart pieces/shapes are displayed as same color or wavelength. Inanother example, the spaced apart pieces/shapes are displayed asdifferent colors. In such an embodiment, the system displays the spacedapart pieces/shapes and iterates the size of the separation until thepatient's inputs indicate that the astigmatism blur of the viewedpieces/shapes are such that the pieces/shapes appear to be just touching(when viewed with each uncorrected eye of a patient at a time). Asdiscussed previously, the system may enable the patient to make one ormore inputs to increase or decrease the spacing between thepieces/shapes, the system may automatically move the pieces/shapes andenable the patient to make at least one input to stop the movement, or acombination of both. As discussed in detail above, the real differencein spacing between the displayed figures/shapes when they appear, to theuncorrected eye of a patient with astigmatism, corresponds to theseverity of the astigmatism (i.e., cylinder). Thus, the systemdetermines a cylinder measurement from the patient's inputs regardingwhen the displayed pieces/shapes appear to be touching.

It should be appreciated that all the astigmatism determination testsdescribed with reference to FIGS. 9A through 16 can consist ofalternating parts in any suitable shapes, including, but not limited tothe squares and rectangles depicted in the Figures, and any suitablenumber or combination of alternating colors in any suitable colorfamilies. It should further be appreciated that whenever a patientcannot see a color change relative to the other figures displayed, itmay be because of one of the following issues: (1) the patient does nothave an astigmatism; (2) the size of the displayed alternating partscorresponds to a higher cylinder error than the patient has; and/or (3)the diagram is not at the patient's axis of astigmatism. To addresssituation (1), the system may enable a patient to make an inputindicating that they do no have an astigmatism. To address situation(2), the system may decrease the size of the alternating parts,re-display the diagram, and query the patient again regarding anyperceived color change. To address situation (3), the system mayre-determine the axis by presenting the patient with a same or with adifferent axis test.

Referring now to FIG. 17 , another embodiment of the present disclosureis illustrated. FIG. 17 is a screen shot of an example of an embodimentof the system of the present disclosure, which demonstrates a possibleconfiguration for a macular degeneration test. By using such a test, thesystem enables a patient to conduct an examination of the locations inwhich they have lost a partial amount or full amount of vision. As iswell-known in the art, it is standard practice for optometrists to testthis using a simple grid on a sheet of paper (lines left to right andtop to bottom) with a marked center. The patient is told to stare at thecenter with one eye at a timeand draw with a pencil any area that appeardistorted, missing, or otherwise different than the rest. Theoptometrist notes in the patient's chart which parts of their retina aredamaged. Such a test is useful for macular degeneration, where patientslose their central vision, as well as other retinal issues such asdiabetic retinopathy, where specific parts of ones vision become missingor blurry. In contrast to this prior art system, the system of thepresent disclosure is more advanced. The system displays a figureincluding a set of curved lines. In the embodiment shown in FIG. 17 ,the figure 1700 has generally semicircular curved lines 1702 opening tothe right, and a center region 1704. The system instructs the patient tofocus on the center region with a single uncorrected eye at a time, andenables the patient to select any lines which appear to have blurry ormissing portions. Alternatively, the system enables the patient toselect the portions of the lines which appear to be blurry or missing.The system then displays a similar set of curved lines, but this timewith the opening facing some other direction, such as left. In oneembodiment, the second figure is displayed as opening to the oppositeside as the first figure. It should be appreciated that the orientationof the curved lines may differ in shape or actual apex angle, and may beany suitable shape or apex angle. The system increases the intensity ofthe user-selected lines or parts of lines and enables the patient tomake at least one input regarding whether their vision is improved inthose areas based on the increase in intensity. In should be appreciatedby one of skill in the art that the at least one input corresponds to amagnification level for that region of a patient's vision, whichcorresponds to a particular location on the patient's retina which hasexperienced at least some vision loss. The system may then use thedetermined magnification level for lens creation to create a specificcustomized lens with precise additional magnification levels in certainlocations to aid in the patient's overall ability to see throughouttheir full field of vision. In one embodiment, the system can be used tokeep track of macular degeneration (or other degenerative visiondisease) at home, and monitor changes as vision changes progress. Itshould be appreciated by one of skill in the art that such routinetesting is important for those with or at risk for vision issues as asudden change or threshold level of change can be detrimental, and mayneed physician evaluation immediately.

In another example embodiment of a vision loss test, the system usesstraight lines instead of the curved lines described above withreference to FIG. 17 . In one such example embodiment, the displayedfirst figure includes vertical lines, and the system enables the patientto make at least one input to select the line or lines, or portions oflines that appear distorted or to have parts missing. The system thendisplays horizontal lines and enables the patient to make at least oneinput to select the line or lines, or portions of lines that appeardistorted or to have parts missing. It should be appreciated by one ofskill in the art that the lines can be any angle or format, anythickness or color, and can also be employed with a combination ofstraight and curved lines, or a combination of semi-straight or modifiedlines in any suitable combination so long as the patient is enabled toidentify, and the system is thus able to determine, the coordinates ofthe section(s) on the patient's retina that correlate(s) to missing orimpaired vision. It should further be appreciated that if thepatient-identified lines are of a type of circular distortion orcircular vision loss, a system such as that described above can easilyidentify that type and can thus isolate any future changes in visionloss that differ from the original regions. One such example of visionloss occurs in those with diabetic changes, or those with advancedmacular degeneration. Traditional vision exams typically only monitorthese changes every six months to a year and do not allow for a steadyprogression analysis to take place. In the system described by thepresent disclosure, the testing and analysis can easily and convenientlybe done with greater frequency such that any changes can be detected ina more accurate and time-sensitive manner. Further, it is contemplatedthat such testing results may be stored and accumulated in a genericdatabase so that the system may compare vision loss data of a specificpatient to that of the general population, by analyzing vision lossbetween right and left eye data points of an individual to that of rightand left eye intervals of that of the entire population or data set ofpatients stored in the database of the system.

In an embodiment, the system includes determining the skew, and thus,quality, of a patient's progressive lenses. Progressive lenses, alsocalled progressive addition lenses (PAL), progressive power lenses,graduated prescription lenses, and varifocal or multifocal lenses, arecorrective lenses used in eyeglasses to correct presbyopia and otherdisorders. Progressive lenses include at least two differentprescriptions in different parts of the lens, and a gradient betweenthem. Generally, the progressive lenses begin with the patient'sdistance prescription near the top of the lens and graduate to theaddition (or reading glasses) power prescription near the bottom of thelens. The gradient can be as smooth or long as is necessary for patientcomfort. However, the progression of the prescriptions in these lensescreate regions of aberration away from the optic axis, causing blur orskew, which varies in relation to the quality of the lens. The higherthe quality of the lens, the lower the blur, while the lower the qualityof the lens, the higher the blur. Thus, it is advantageous to informpatients of the blur inherent in progressive lenses, its causes, andoptions for decreasing blur and increasing clarity. In one exampleembodiment, the system displays a figure. In a further exampleembodiment, the displayed figure is a grid of lines, similar to thatshown at reference numeral 408 a in FIG. 4A, or that described abovewith reference to the optometrist-based prior art macular degenerationtest. It should be appreciated that the system may fill an entirecomputerized screen with such a grid, or a portion of the computerizedscreen. The system instructs the patient to view the displayed figurewith one corrected eye (wearing a progressive lens) at a time. Thesystem enables the patient to make at least one input to identify areasof distortion or blurriness. It should be appreciated that any suitablemethod of user-input may be enabled, such as outlining or drawing with acursor, simple point-and-click selection, via a touch screen, via aremote control, by voice control, or by other known input devices andmethods. The system may then describe the amount of distortion presentin the lens by a simple percentage (i.e. if the patient selects 5percent of the blocks as distorted or blurry, they would have 5%distortion) and advise the patient what reduction in level of distortiona higher quality lens might yield.

It should further be appreciated that both the vision loss test and theprogressive lens check test described in the preceding paragraphs can beemployed by the system displaying a simple Amsler grid image with linesrunning up and down and left to right and enabling a patient to selectthe areas that look blurry or missing via any suitable input andselection means. It should further be appreciated at any suitable colorcombination may be used, such as black lines on a white background(black-on-white), blue-on-yellow, blue-on-red, white-on-red, or anyother suitable combination of colors.

In another example embodiment of the present disclosure, the systemincludes a visual field test. Typically, a patient tests their visualfield using a specific machine located in-office at a doctor visit. Theconventional visual field testing machine operates as follows: a patientplaces their head against or into a machine and looks through aviewfinder. The machine tests each eye individually (by for example,blocking the view of the eye not being tested) and instructs the patientto focus their eye on a center dot, and click a button (or other inputdevice) with their hand to select when they can see a dot beingprojected into their field of view through the viewfinder. The machineflashes dots relatively quickly, and if a patient does not make an inputthat they saw a dot, the machine marks the spot associated with that dotas having some vision loss. Often, the machine will re-test those areaslater, lengthening the process for testing the patient. When performedat a doctor's office, the test is often difficult and uncomfortable fora patient to take. Many patients find it difficult to concentrate forsuch a long period of time, and elderly patients often end up fallingasleep while taking the test. Nevertheless, a visual field test is animportant diagnostic tool used for the determination and routine followup patients with glaucoma, brain tumors, diabetes, and many otherconditions. Thus, it would be advantageous to provide a visual fieldtest which may be conducted at a location remote from a doctor's officeand convenient for the patient, such as in the patient's home.Additionally, at a remote location, the patient may take their time withtest, and pause the test if they become distracted or tired, thusyielding a more accurate result. In an example embodiment of the presentdisclosure, the system includes a visual field test that a patient isenabled to take at a location remote from a doctor's office. In such asystem, the patient may be instructed to focus on a central dot (orother shape) as is conventional, or may be instructed to focus on acursor present on the computerized screen. As is typical, the systemtests one eye of a patient at a time while focusing on a location. Aweak dot (or other suitable shape or figure) is displayed on the screen,in an area corresponding to a part of the patient's visual field, andthe patient is enabled to make at least one input to connote that theysaw the dot. Any suitable input method may be employed by the system,such as enabling the patient to move their mouse over to that area thedot appeared to click it, touching the area (if using a touch-screendevice), selecting a button, voice control, or other suitable methods.If the patient is too slow to make the at least one input, the systemwill flash another dot on the computerized screen and flag that area tore-test or as having some vision loss. The time interval for displayingthe dot on the computerized screen is generally fast, and may be anysuitable amount of time, such as 0.2 seconds. The system enables thepatient to make at least one input to cause the display of the dot to beadjusted (longer or shorter). Once the system has at least fully testedthe locations in patient's visual field and received any associatedinputs from the patient, it determines the patient's visual field basedon those recorded inputs, and any lack of recorded inputs. The systemmay further adjust the light intensity of the displayed shape or figure,or display the shape or figure in any suitable color or combination ofcolors.

One potential issue with such a system is that a patient may move duringthe test (even if instructed not to) which would cause the location ofthe dots on the screen to become associated with a new position on thepatient's eye. Thus, the system may include a method to determine if thepatient has moved during the test. One possible method is to determineand periodically check the location of the patient's blind spot. As isknown in the art, each person has a physiological blind spot in each eyewhere the optic nerve passes through the optic disc of the retina sincethere are no light-detecting photoreceptor cells at that location. Theblind spot location may be determined via methods well-known in the art,such as by displaying two shapes or figures a known distance apart andinstructing the user to cover one eye, look at the shape or figureopposite that eye, and move their eye closer to or further from thescreen until the shape or figure disappears. The other side of the blindspot is determined by when the opposite effect occurs. The system mayalso periodically display dots in the blind spot of the patient. If thepatient makes at least one input connoting that they see a dot thatshould have been in their blind spot, the system will determine that thetest has become inaccurate and recalibrate based on the new location ofthe patient. It should be appreciated that any suitable method ofdetermining whether a patient has moved may be employed by the system inaddition to or in place of the above-described methods.

Another potential issue with such a system is that the patient needs toknow how far away from the screen to place their eye. Thus, the systemmay include a method to determine how far the patient needs to be. Onepossible method is to use the determined location of the patient's blindspot, as is conventional and described above. Alternatively, the systemmay use any suitable distance calcuation method, such as those known inthe art or described herein.

It should be appreciated by one of skill in the art that a staticquestion-based system, as opposed to a dynamically-changing-images-basedsystem, may be utilized by the system. In an example embodiment of astatic question-based system, the system may display four figures, threeidentical, and one different. The system would enable the patient tomake at least one input to identify the different figure. In such asystem, the figures might begin relatively large in size, and as thepatient correctly selects the different figure, the system wouldsteadily decrease the size of the displayed figures until the patient isno longer able to correctly select the different figure. It should beappreciated by one of skill in the art that if the starting size, therate of decrease in size, and the number of correct inputs are known,the system can calculate the appropriate sphere measurement for thepatient's prescription. It should further be appreciated that any kindof figure may be used, such as letters, numbers or shapes, that anysuitable number of figures greater than one can be used, such as 2, 3, 4or more, and that any suitable number of similar or different figuresmay be used. For example, the system may display five figures, threeidentical and two different. It should also be appreciated that anysuitable input device may be used, such as clicking via a cursor, mouse,or trackpad, via a touch screen, via a remote control, by voice control,or by other known input devices and methods.

In another embodiment, the system includes the measurement of thecorneal surface of a patient. In such a system, the patient's eye isilluminated with a series of concentric rings of any suitable number,such as two, three, four, five, six, or more, having a known distancebetween each ring. In one example embodiment, the rings are each thesame known distance apart. In another example embodiment, at least onering is a different known distance apart from its neighboring rings. Theillumination of the patient's eye may occur in any suitable manner, suchas via projection. After the patient's eye has been illuminated, thesystem takes a picture of the patient's eye illuminated with theconcentric rings. In an alternative embodiment, the system enables thepatient (or an assistant of the patient) to take the picture using thesystem, or using another mode of the patient terminal on which thesystem is being used. In another alternative embodiment, the systeminstructs the patient (or an assistant of a patient) to take the pictureusing a separate camera device, such as may found in a digital camera, acamera phone, a camera-enabled computer or tablet, or any other suitablecamera device. Applicants have surprisingly found that the distortion inthe spacing between the concentric rings as they appear illuminated onthe eye of a patient corresponds to the topology of the patient'scornea. In particular, Applicants have surprisingly found that when theilluminated concentric rings appear closer together, the cornealstructure is steeper, whereas if the illuminated concentric rings appearfurther apart, the corneal structure is flatter. Thus, the system isable to determine the exact corneal steepness based on the separationdistance between the illuminated corneal rings compared to the originalknown separation between the concentric rings. The system is also ableto detect if the patient's cornea has a malformed surface, such askeratoconus or an injury based on the appearance of the illuminatedconcentric rings on the patient's eye.

In another embodiment the system includes a pupillary distancemeasurement module. It should be appreciated by one of skill in the artthat most inner (medial) and outer (lateral) canthal distances areroutinely within a small range around approximately 3 cm in allcultures, races, and genders, as long as the individual is of adult age(generally considered to be 18 years of age or older). Applicants havesurprisingly found that, from this known range, the system can determinethe scale of an image, and thus calculate additional desired distances,such as a patient's pupillary distance. Once the system has determinedthe pupillary distance of the patient from an image of the patientbased, in part upon the scale of the image and the known canthal ranges,the system may enable the patient to virtually and view various glassesframes sized to fit the image of their face, and their determinedpupillary distance. In such an embodiment, the system may display animage of the patient with mock eyeglass frames displayed over the top ofthe patient's face, and may enable the patient to modify the appearanceof the frames, for example, by changing the size, shape, color,material, texture, etc. of the mock frames. It should be appreciated byone of skill in the art that other desired facial measurements may bedetermined by the system based upon the known canthal distances, andthat any other desired clothing or accessories may be virtually “fit”via the methods disclosed herein. One of skill in the art should furtherappreciate that the methods disclosed herein may be applied outside ofthe context of the facial structure to any part of a human or animalbody known to have a standard or approximate standard size, and thus maybe used to virtually browse and “fit” any suitable type of clothing oraccessory, matched to the size of the underlying image.

In another example embodiment, the system includes a method ofdetermining a pupillary distance measurement of a patient wherein thepatient does not need to utilize an outside source of measurement. Knownprior art systems determine distances remotely by, for example,requesting the patient to take a photograph of their face, whilesimultaneously hold up an object of known size (such as a credit card orother real life object) nearby to their eyes in order for the system toscale how far apart the patient's eyes are. However, in the exampleembodiments of the present disclosure, the system does not require theuse of any real life object to scale an image of a face because itutilizes average sizes of an adult eye. In other words, the systemutilizes at least the average canthal distances across all races andgenders in order to determine an average fixed position in real space asdescribed above. The system then determines the distance between thepupils of the patient based on an image of the patient (either takendirectly of the individual using a web camera, phone camera, or anyother suitable camera or video device, or taken from a previousphotograph of the patient), scaled according to the canthal regions ofthe patient and the determined average canthal distance (at least inpart) to determine the pupillary distance of an patient's face.

It should further be appreciated by one of skill in the art that theabove-described pupillary distance module can be used to calculate otherfacial characteristics or biometric data which may be used to uniquelyidentify an individual. For example, the system may use the knowncanthal distance to calculate the face width and/or height of a patientpositioned in any suitable manner, such as straight-on to the camera, orfull or partial profile. It should be appreciated that biometric datacalculated by the system (such as pupillary distance, or other facialdimensions) may be used by a camera-enabled device to lock or unlockaccess to various applications on the device (or the device itself)based on a comparison between the biometric data known by the device andthe biometric data of the person sensed by the camera of the device. Ifthe known biometric data and the sensed biometric data are similar to ahigh-enough degree (such as the same, a statistically insignificantdifference apart, or close to the same within a confidence range) thenthe device will identify the sensed person as the known person and allowthe sensed person access. It should be appreciated that such abiometric-based system works because certain facial proportions andmeasurements are unique to individuals. Potential problems with such asystem include that a person unknown to the system may try to trick thesystem into authenticating a photograph or video of the known person.The system would then recognize the biometric data of the photograph orvideo and allow access without the known person actually being present.To avoid these problems, the system may instruct the person desiringaccess to blink an eye (or blink either or both eyes in a random orpredetermined combination or pattern). It should be appreciated by oneof skill in the art that any suitable and system-recognizable facialexpression or combination of facial expressions may be used (e.g. asmile and a wink, sticking a tongue out, etc.). If the camera-enableddevice is also flash enabled, the system may activate the flash todetermine whether there is an actual person (as opposed to a recordingor photograph) present. In activating the flash, a person would still bevisible to the camera sensor, but the photograph or video would bewashed out and difficult to sense. The system may also sense or detectshadows on the face (and whether they change) to confirm a real personis present.

In a further embodiment, the pupillary distance measurementsystem/biometric access system may enable the known person to access tolock or unlock access to various applications on the device (or thedevice itself). In this further embodiment, different suitable andsystem-recognizable facial expressions or combinations of facialexpressions may be used to access or quit out of different applications(or the device itself). For example, the patient may stick their tongueout to access the device, may wink the right eye then the left eye toaccess one application, such as a mailbox, then may wink the left eyefollowed by the right eye to access a second application. It should beappreciated that these combinations of suitable and system-recognizablefacial expressions may be used as shortcuts to perform actions inside anapplication as well as to provide access (or close out of) applicationsor the device itself.

In another embodiment, the system includes an air puff tonometer test.Such a test may be implemented for a mobile device, in a stand-alonelocation, in a kiosk-type setting, or in any suitable location, such asby utilizing a small and simple attachable reflexive device that ejectsa force of air through a small tiny opening by methods known in the art.It should be appreciated by one of skill in the art that the puff of airwill be forced onto the cornea of a human or non-human eye, in order tomeasure its intraocular pressure. Such an attachable reflexive devicemay include a high powered photographic lens system that will allow thecamera to determine how much the cornea has flattened in response to thepuff of air. In an alternate embodiment, the system includes a sensor tomeasure a apushback or return of air to the sensor after the air hasbeen puffed to the patient's cornea. It should be appreciated by one ofskill in the art that the sensor is capable of measuring the amount ofair return in both intensity and delay. In such an embodiment, thesystem determines the intraocular pressure of the patient based on thesensor measurements. It should further be appreciated that the systemmay utilize more than form of measurement and/or more than one iterationof measurement to ensure accuracy. In using such a attachable reflexivedevice, the patient is enabled to measure their intraocular pressure inthe manner most convenient or comfortable for the patient.

In another embodiment the system includes capability to allow thepatient to query a database of eyeglass frames. In one exampleembodiment of such a system, the system enables a patient to photographeyeglass frames which they like, or which they already own, and inputthe image into the system. In a further embodiment, the system mayinstruct the patient to take the photograph of the frames straight on,as well as with one or two side views of the frames, while the framesare either on or off of the patient. The system utilize the photographor photographs to determine frame characteristics such as size, shape,size, color, texture, materials, or any other suitable characteristic toquery the database of frames known to the system for matching or similarframes which the patient may prefer. The system may determine thecharacteristics of the photographed frames in any suitable manner, suchas a quick wireframe analysis of the frames on the patient's face. Asdisclosed herein, the system is enabled to determine the necessarydimensions of the patient's face to accurately determine matching orsimilar frame selections to display to the patient. In one exampleembodiment of such a system, patients may browse frames at their localoptical shops, and take photographs of their preferred frames, then usethe disclosed online, mobile phone application, or kiosk-based system topurchase a pair of frames that are close in shape, size, color, or anyother characteristic. In another example embodiment, the system mayquery the database based on a picture of someone other than the patient,such as a picture provided by the patient of someone unknown to thesystem, or a picture from a publication, such as a magazine.

In one example embodiment, the system determines near and/or farsightedness by observing behavior and using the properties ofnearsighted and farsighted patients. Nearsighted people can see nearthings more clearly than they can see things that are farther away,while farsighted people can see far things more clearly than they cansee nearer things. In an embodiment to test for nearsightedness andfarsightedness, the system can determine which condition the patient isexperiencing by instructing the patient to view a near image and a farimage simultaneously (or near simultaneously), then enabling the patientto make an input reflecting which image appears more clearly. In oneembodiment, the near image would be about a foot away from acomputerized screen, such as a computer monitor and the far image wouldbe more distant than about a foot away, such as an a computerized screenheld at arm's length (such as a smartphone in an extended arm of thepatient). In another embodiment, the near image would be a computerizedscreen held at arm's length (such as a smartphone in an extended arm ofthe patient) and the far distance can be more distance that arm'slength, such as 6-10 feet away from a computerized screen, such as acomputer monitor, kiosk, or tablet. Once the patient can view the twoimages at the different distances, the system instructs them to make aninput regarding whether they can see some detail of the image. Forinstance, in an embodiment where the image is a series of characters,the system may ask the patient to make an input when they can identifywhich character is different from the others, using one uncorrected eyeat a time. The system enables the patient to make at least one input toreflect the smallest sized image of which they can make out thesystem-identified detail by adjusting the sizes of the images usingmethods described in detail elsewhere in this disclosure. The image maybe kept the same on both screens (increased and decreased together) ormay be different sizes on each screen. Based on the patient's inputsregarding the smallest size image they can see a detail of close and faraway, the system can determine whether the patient is nearsighted orfarsighted. In a further embodiment, the system additionally uses redand green overlays on the images in order to either increase or decreasechromatic aberration.

The near and far distances the system instructs the patient to use maybe based on age. This would be advantageous since younger people tend tohave better near vision than older people, because as one ages, oneloses some of their ability to accommodate for close reading. Thus, thesystem takes age into account to yield a more accurate determination. Inone embodiment, the system determines the positioning of different-agedindividuals by using a visual field. For instance, the system maydisplay a figure with a portion on the right side of the screen (an “X”for example, when the patient is testing their uncorrected right eye)and a portion on the left side of the screen (such as a vertical line).The patient is instructed to move their eye towards the X, until theycannot see the vertical line in their peripheral vision. Someone who is40 years old will have a vertical line further away from the X, than saysomeone who is 20 years old, because the 20 year old individual mustmove their head closer to the computer screen before they can no longersee the X in their peripheral vision.

In another embodiment, the system includes a sound vibration ocularpressure sensor to determine the ocular pressure of a patient. It shouldbe appreciated by one of skill in the art that such as system is basedon the known fact that objects will vibrate in response to sound waves.Applicants have surprisingly found that the various types andfrequencies of sound waves correlate directly to the associatedvibration that occurs in the cornea based upon the ocular pressure, andthat these vibrations are measurable by a camera sensor capturingchanges in light reflections from a camera or by a microphone or othersuitable sensor that captures the frequency of the sound reflected backfrom the pulsated eye. The system pulsates sound waves in any suitablestandard or variable frequency against the corneal structure of thepatient, then measures the vibration of the cornea to determine thepressure inside the cornea. Applicants have surprisingly found thatchanges in the light reflections from a camera or measured frequency ofreflected sound from a pulsated eye correlate with the vibration in thecornea based upon the ocular pressure. Applicants have furthersurprisingly found that such systems are functional using ultrasonicsound waves, infrasonic sound waves and/or acoustic sound waves. In oneexample embodiment, a combination of infrasonic and acoustic sound wavesare pulsated in various time intervals and intensities and sound/decibellevels, and the patient's cornea vibrates in accordance to the variouslevels and in accordance with its internal pressure. It should beappreciated by one of skill in the art that any suitable speaker ordevice may generate the sound waves, such as the standard speaker on acell phone, tablet, or personal computer.

In another embodiment, the system includes a high powered plus lens toisolate hyperopia and hyperopic prescriptions. This lens may be includedor simulated in any suitable application, such as in a personal computerapplication, a mobile phone application, or in a kiosk-basedapplication. It should be appreciated by one of skill in the art that ahigh powered plus lens enables the system to correct for latenthyperopia, as well as isolate the patient from using their eye muscles'natural accommodative ability to focus through a slightly incorrectprescription, thus enabling the system to provide a more accurateprescription.

In another embodiment, the system includes an additional method todetermine the distance between the patient and the computerized screenof the patient terminal, or other desired distances, such as pupillarydistance. The system relies upon the known canthal distance of the adultpatient and an additional data point to calculate the distance betweenthe terminal or camera and the patient. The additional data point can beany suitable data point, such as the height of the patient (if theterminal or camera can see the entire height of the patient), or knowncamera specifications of particular device or patient terminal. Thesystem uses this known information to determine the distance between theterminal or camera from the patient. In one example embodiment, thesystem may know the canthal distance of the patient is appoximately 3cm, and may determine that on the image of the patient from a knowncamera device (such as from a camera of known manufacture) that canthaldistance is represented by a certain number of pixels, then the systemmay, from these known points, identify the scale of the image of thepatient, and thus the distance between terminal or patient. In analternative embodiment, the system uses (or instructs the patient to useone or more of) two camera devices separated vertically or horizontallyby a known distance to measure the desired distance (distance betweenthe patient and the camera devices, or some other desired distance). Itshould be appreciated by one of skill in the art that such a system mayalso be used to determine pupillary distance.

It should be appreciated that each of the disclosures above may beimplemented in a kiosk-type system, either singly, individually, or incombination with several kiosks, to provide a complete eye examinationto evaluate various parts of the eye and refractive system. Examples ofvarious types of known systems which may be incorporated into such asystem include: an eye pressure measurement system, a photographingsystem for the photographing the front and/or back of the eye, arefraction system, and a system to measure all ancillary tests of an eyeexam. In one example embodiment, the system includes a distance rangefinder to determine the distance a patient moves their eye away from ascreen, and enables the patient to make a input at the distance theyfirst notice an image being sharp with each individual eye. It should beappreciated that in such an embodiment, the test will be done with eacheye independently, and any suitable number of times, such as one time,two times, three times, or more. The systems determines a portion of aprescription for the patient based on these one or more tests, and basedin part on the principle that the focal point of an eye corresponds tothe dioptric power error of an eye, in that the measurement of initialclose focus is 1/distance, where distance is in meters. It should beappreciated that such a system operates without the need to for thepatient to move their footing position away from their current position.

In another example embodiment, the system is embedded into a kiosk-basedstructure, enabling the patient to undergo any of thetesting/diagnostics described herein in any location that the kiosk islocated in, which may be any suitable location including locations in ornearby to an eyeglasses and/or contacts retail location, an genericretail location, such as a shopping mall or store front, an optometristor ophthalmologist's office, another type of doctor's office, nearby toDepartment of Motor Vehicles or Secretary of State facilities, or anyother location. It should be appreciated by one of skill in the art thatan advantage to a kiosk-based system in accordance with the presentdisclosure would be that such as system would not need to utilize anylens assemblies in order to refract the patient. The kiosk couldtherefore be completely lens free in order to determine a refractiveprescription for a patient. This would save the kiosk manufacturer oroperator both money and effort in development, as well as bulkiness andcomplexity in the overall structure. The kiosk-based system may includeany of the features described herein, in any suitable combination ornumber including a lensless refraction system, eye health testing,biometric testing, a system to grind lenses, a system to print offrames, etc. One of skill in the art should appreciate that a greaternumber of features may provide increased convenience to the patient, forexample, if the system could refract a patient, generate a correctivelenses prescription, and provide the patient with the prescribedcorrective lenses in a one-stop location and time period. It shouldfurther be appreciated by one of skill in the art that a kiosk-basedsystem would be unique from an in-home lensless experience (as alsodescribed herein), for several reasons, including because offunctionality described above which would not be practicable in an-in-home setting (such as lens grinding or frame printing) or because itcould require smaller distances (and space requirements) by use of aconventional mirror arrangement as is well-known in the art. Mirrorarrangements of this sort are routinely used in doctors' offices tosimulate 20 feet when, in fact, most offices only have less than 12 feetof total distance available due to the high cost of rent or to maximizeexam rooms.

In another further embodiment, the system is an all-in-one correctivelenses production device that will determine the patient's prescriptionin the manners described herein, and enables a patient to select aglasses frame and a type, color and coating for a lens, as is known inthe art. The system will then create the frame while the patient waitsvia a 3D printer or other known methods, and create the lens with agel-type system that creates the lens and hardens the lens while thepatient waits, or by any other method which is known in the art for thecreation of lenses. An entire system in accordance with this embodimentadvantageously provides convenience for the patient, as it contains thethree necessary components to finalize a pair of spectacles: aprescription, a frame, and lenses.

It should be appreciated by one of skill in the art that for variousmodules or portions of the present disclosure which do not require inputfrom a patient, or which are not subjective in nature, the patient maybe any suitable patient. For example, the patient may be non-human, suchas a pet or a wild animal. In another example, the patient may be of anage or ability level which makes communication difficult, such as achild or a developmentally delayed person. It should further beappreciated that for such patients, the system may instruct an assistantto the patient on proper positioning and any necessary inputs.

In another embodiment, the system determines the former spectacleeyeglasses prescription (myopic, hyperopic, astigmatic, or anycombination thereof) of a patient without requiring a writtenprescription copied into a fillable form by the patient. The systemrequires only a camera, a computerized screen, and a pair of spectaclelenses. The patient places the camera lens a known distance from acomputer monitor. In one example embodiment, an easy way to set ordetermine the known distance is to use a standard piece of paper (8.5×11inches) to select the placement of the camera device and/or thecomputerized screen. In one embodiment, the system instructs the patientto place the camera device 11 inches (or some other distance) from thecomputerized screen. In another example embodiment, the patient selectsthe distance between the camera device and the computerized screen andthe system enables the patient to input the selected distance. Once thecamera device has been placed a known distance from the computerizedscreen, the patient takes a control picture of the computerized screen,then places one of the spectacle lenses against the camera lens andtakes a second picture of the computerized screen. The patient thenplaces the other of the spectacle lenses against the camera lens andtakes a third picture of the computerized screen. The computerizedscreen may display any suitable high-contrast figure, such as a grid orspaced dots. The system receives the control picture, first lenspicture, and second lens picture from the camera device via methods fordata transfer that are well known in the art, such as though a wiredconnection (Universal Serial Bus (“USB”), Firewire, Thunderbolt™, etc.),wireless connection (Bluetooth®, etc.), or via cellular data or internetconnections. It would be appreciated by one of skill in the art thatplacing the spectacle lens over the camera lens will distort, or change,the visual appearance of figure displayed by the system on thecomputerized screen. Applicants have surprisingly found that bymeasuring the amount and direction of distortion of the first and secondpictures from the control picture over a known distance, the system isable to determine the prescription of the first and second spectaclelenses without a written prescription document.

In another example embodiment the system utilizes a screen that is ableto focus its light rays in more than one direction, and at variouspoints in space, such that it is able to specifically focus light rayswithin a designated small space to make for a more optimal viewinglocation. This display unit will therefore allow a patient to see animage in focus, regardless of their vision correction, because thedisplay will aim the rays towards the patient and can adjust in realtime the rays of light and their position for the user.

In a further embodiment, the system determines both cylinder and axismeasurements of a patients' refractive error for each eye at a time byusing a single figure on a screen. The patient is enabled to view thefigure (using one uncorrected eye at a time) and is enabled to input tothe system the extent and reach of the patients' perception of anydoubling or overlap effect. It should be appreciated by one of skill inthe art that any suitable way of measuring or inputting the doubling oroverlap effect can be utilized, such as by expanded or concentricadditional figures, or by enabling the patient to place markers where atthe outer bounds of the perceived doubling or overlap effect. It shouldfurther be appreciated that any suitable figure may be used by thesystem such as a simple shape, symbol, icon. Applicants havesurprisingly found that the perceived doubling or overlap effectcorresponds to the axis (by demonstrating the angle the astigmatismcauses distortion along) and cylinder (by demonstrating the extent ofthe astigmatism distortion) measurements of the patient.

In another embodiment, the system can determine either an astigmatismcylinder or axis by displaying a spinning symbol and enabling a patientto view the spinning figure with one uncorrected eye at a time and makean input when the figure appears as a single figure without any residualdoubling or overlap effect. It should be appreciated that any suitablefigure may be used by the system such as a simple shape, symbol, icon.Applicants have surprisingly found that the disappearance of thedoubling or overlap effect caused by an astigmatism corresponds to theaxis (by demonstrating the angle the astigmatism causes distortionalong) and cylinder (by demonstrating the extent of the astigmatismdistortion) measurements of the patient.

In another further embodiment, a system may enable a patient to undergoan additional number of examinations after their initial examination. Inone example embodiment, at least one of the additional examinations isperformed by the patient using their corrected eyes based on theprescription determined by the system in their initial examination. Thesystem may use the additional number of examinations to refine thecorrelation of tests performed by the system to the most accuratemeasurement of the patient's prescription.

In an embodiment, the system includes determining any particular areasof a patient's vision loss or reduction throughout their full field ofvision. In one example embodiment, the system displays a figure. In afurther example embodiment, the displayed figure is a grid of lines,similar to that shown at reference numeral 408 a in FIG. 4A. The systeminstructs the patient to view the displayed figure with one uncorrectedeye at a time, and look to or at a center point of the figure. Thecenter point of the figure may be marked or otherwise identified. Thesystem then enables the patient make at least one input to select areasin the figure which appear distorted, missing, or otherwise differentthan the rest. The system can use this at least one input to furthertest the areas of vision loss by either magnifying those certain spotsof vision loss, or altering their shapes or intensities to determine ifthe patient can notice vision improvement. The patient continues to lookto or at the center of the figure while the system adjusts at least oneof the shape, intensity, color, or other suitable characteristic of eachidentified area of vision loss. The system enables the patient to makeat least one input per previously-identified area of vision loss toconnote one or more of the following: (i) the adjustment helped to makethe area more clear/less distorted, (ii) the adjustment did not help tomake the area more clear/less distorted, (iii) the adjustment made thearea clear and not distorted, and (iv) the area is still missing,blurry, or distorted despite the adjustment. The system may theniteratively adjust at least one of the shape, intensity, color, or othersuitable characteristic of each identified area of vision loss and againenable the patient to make one or more of the four above-identifiedinputs. This iterative process may continue until each identified areahas been adjusted to appear clear and not distorted to the uncorrectedeye of the patient, wherein the adjustment to size, intensity, or othercharacteristic of each area corresponds to a magnification of aparticular location of a spectacle lens. In one example embodiment, theadjustment correlates to the base curve of the lens at that particularlocation. As an example, if the patient was found to have no distanceprescription, but the system identified two areas of vision loss thatneeded increased magnification with 2 levels of increase (diopters), anexample base curve modification would be −4 diopters on the back curveof the lens, and +4 diopters on the front, but +6 curve on the areasthat need 2 levels of magnification. This is because a lens has twocurved surfaces affecting the vision of the wearer: the front surfaceand the back surface. The corrective power of a lens is determined byadding the front curve to the back curve. This is expressed by theequation: F1+F2 =FTotal. Applicants have surprisingly found thatadjusting a figure to correct for vision loss in particular areascorrelates to base curve measurements for the corresponding locations ofa spectacle lens. Possible applications of the above-described systeminclude aiding those patients with macular degeneration, glaucoma,diabetic retinopathy, or other retinal diseases which cause loss of someor all vision in certain locations.

In a further embodiment, the system includes grinding or laser-cuttingcustom lenses based on the results and prescriptions of the testsdescribed herein. As is well-known in the art, spectacle lenses may bemade of glass or plastic, such as lightweight polycarbonate plastic,CR-39 plastic, or high index plastic lenses. Lenses are generallystarted as “blanks,” which are already cut to an approximate basecurve/power and need only to be fine tuned to the prescription of eachpatient. These “blank” lenses are then conventionally processed bygrinding and polishing, or laser cutting, edging, and coating. In oneembodiment, the system grinds lenses for a patient who has an especiallynarrow or wide astigmatism angles. In another embodiment, the systemgrinds lenses with different base curve (diopter) values in differentlocations to correct for vision loss in those particular areas fromdiseases such as macular degeneration, glaucoma, diabetic retinopathy,or other retinal diseases. It should be appreciated that such a lenswould magnify or minify some parts of patient's sight to adjust for thepatient's weakness in parts of their eyesight. In a further embodiment,the transitions between the base curve changes are smooth (as they arein no-line bifocal lenses).

The present disclosure contemplates a variety of different systems eachhaving one or more of a plurality of different features, attributes, orcharacteristics. It should be appreciated that a “system” as used hereinrefers to various configurations of: (a) one or more central servers,central controllers, or remote hosts; and/or (b) one or more patientterminals, such as desktop computers, laptop computers, tablet computersor computing devices, personal digital assistants (PDAs), mobiletelephones such as smart phones, kiosk devices, and other mobile orstationary computing devices.

For brevity and clarity, unless specifically stated otherwise, “patientterminal” as used herein represents one patient terminal or a pluralityof patient terminals, and “central server, central controller, or remotehost” as used herein represents one central server, central controller,or remote host or a plurality of central servers, central controllers,or remote hosts.

As noted above, in various embodiments, the system includes a patientterminal in combination with a central server, central controller, orremote host. In such embodiments, the patient terminal is configured tocommunicate with the central server, central controller, or remote hostthrough a data network or remote communication link.

In certain embodiments in which the system includes a patient terminalin combination with a central server, central controller, or remotehost, the central server, central controller, or remote host is anysuitable computing device (such as a server) that includes at least oneprocessor and at least one memory device or storage device. As furtherdescribed below, the patient terminal includes at least one processorconfigured to transmit and receive data or signals representing events,messages, commands, or any other suitable information between thepatient terminal and the central server, central controller, or remotehost. The at least one processor of that patient terminal is configuredto execute the events, messages, or commands represented by such data orsignals in conjunction with the operation of the patient terminal.Moreover, the at least one processor of the central server, centralcontroller, or remote host is configured to transmit and receive data orsignals representing events, messages, commands, or any other suitableinformation between the central server, central controller, or remotehost and the patient terminal. The at least one processor of the centralserver, central controller, or remote host is configured to execute theevents, messages, or commands represented by such data or signals inconjunction with the operation of the central server, centralcontroller, or remote host. It should be appreciated that one, more, oreach of the functions of the central server, central controller, orremote host may be performed by the at least one processor of thepatient terminal. It should be further appreciated that one, more, oreach of the functions of the at least one processor of the patientterminal may be performed by the at least one processor of the centralserver, central controller, or remote host.

In certain such embodiments, computerized instructions for controllingany screens, displays, or interfaces displayed by the patient terminalare executed by the central server, central controller, or remote host.In such “thin client” embodiments, the central server, centralcontroller, or remote host remotely controls screens, displays, orinterfaces displayed by the patient terminal, and the patient terminalis utilized to display such screens, displays, or interfaces and toreceive one or more inputs or commands. In other such embodiments,computerized instructions for controlling screens, displays, orinterfaces displayed by the patient terminal are communicated from thecentral server, central controller, or remote host to the patientterminal and are stored in at least one memory device of the patientterminal. In such “thick client” embodiments, the at least one processorof the patient terminal executes the computerized instructions tocontrol screens, displays, or interfaces displayed by the patientterminal.

In certain embodiments in which the system includes a patient terminalconfigured to communicate with a central server, central controller, orremote host through a data network, the data network is a local areanetwork (LAN) in which the patient terminal is located substantiallyproximate to the central server, central controller, or remote host. Inone example, the patient terminal and the central server, centralcontroller, or remote host are located in an eyeglasses and/or contactsretail location. In another example, the patient terminal and thecentral server, central controller, or remote host are located in anoptometrist's or ophthalmologist's office.

In other embodiments in which the system includes a patient terminalconfigured to communicate with a central server, central controller, orremote host through a data network, the data network is a wide areanetwork (WAN) in which the patient terminal is not necessarily locatedsubstantially proximate to the central server, central controller, orremote host. For example, the customer terminal is located: (a) in anarea of an eyeglasses and/or contacts retail location different from anarea of the eyeglasses and/or contacts retail location in which thecentral server, central controller, or remote host is located; or (b) ina eyeglasses and/or contacts retail location different from theeyeglasses and/or contacts retail location in which the central server,central controller, or remote host is located. In another example, thecentral server, central controller, or remote host is not located withina eyeglasses and/or contacts retail location in which the patientterminal is located. In still another example, the customer terminal islocated: (a) in an area of an optometrist's or ophthalmologist's officedifferent from an area of the optometrist's or ophthalmologist's officein which the central server, central controller, or remote host islocated; or (b) in an optometrist's or ophthalmologist's officedifferent from the optometrist's or ophthalmologist's office in whichthe central server, central controller, or remote host is located. Inanother example, the central server, central controller, or remote hostis not located within an optometrist's or ophthalmologist's office inwhich the patient terminal is located. It should be appreciated that incertain embodiments in which the data network is a WAN, the systemincludes a central server, central controller, or remote host and acustomer terminal each located in a different eyeglasses and/or contactsretail location in a same geographic area, such as a same city or a samestate. It should be appreciated that systems in which the data networkis a WAN are substantially identical to systems in which the datanetwork is a LAN, though the quantity of patient terminals in suchsystems may vary relative to one another.

In further embodiments in which the system includes a patient terminalconfigured to communicate with a central server, central controller, orremote host through a data network, the data network is an internet oran intranet. In certain such embodiments, an internet browser of thecomputer terminal is usable to access an internet page from any locationwhere an internet connection is available. In one such embodiment, afterthe internet page is accessed, the central server, central controller,or remote host identifies a patient prior to enabling that player toenter any data or participate in any tests. In one example, the centralserver, central controller, or remote host identifies the patient byrequiring a patient account of the patient to be logged into via aninput of a unique username and password combination assigned to thepatient. It should be appreciated, however, that the central server,central controller, or remote host may identify the patient in any othersuitable manner, such as by validating a patient tracking identificationnumber associated with the patient; by validating a unique patientidentification number associated with the patient by the central server,central controller, or remote host; or by identifying the patientterminal, such as by identifying the MAC address or the IP address ofthe internet facilitator. In various embodiments, once the centralserver, central controller, or remote host identifies the patient, thecentral server, central controller, or remote host enables the entry ofany patient data and the participation in any tests, and displays thosetests and screens, displays and interfaces via the internet browser ofthe patient terminal.

It should be appreciated the system of the present invention may beimplemented via any suitable method, such as any computer readablemedium. In one embodiment, the computer readable medium is softwareembedded in a website. In another embodiment, the computer readablemedium is software on a non-transitory medium, such as a CD-ROM, storagein local memory at the patient terminal, or the like. In anotherembodiment, the system is provided in an application programminginterface (“API”) which may be individually licensed to third parties toinclude in their websites or other media.

It should be appreciated that the central server, central server, orremote host and the patient terminal are configured to connect to thedata network or remote communications link in any suitable manner. Invarious embodiments, such a connection is accomplished via: aconventional phone line or other data transmission line, a digitalsubscriber line (DSL), a T-1 line, a coaxial cable, a fiber optic cable,a wireless or wired routing device, a mobile communications networkconnection (such as a cellular network or mobile internet network), orany other suitable medium. It should be appreciated that the expansionin the quantity of computing devices and the quantity and speed ofinternet connections in recent years increases opportunities forpatients to use a variety of patient terminals to participate in eyetests from an ever-increasing quantity of remote sites. It should alsobe appreciated that the enhanced bandwidth of digital wirelesscommunications may render such technology suitable for some or allcommunications, particularly if such communications are encrypted.Higher data transmission speeds may be useful for enhancing thesophistication and response of the display and interaction with players.

It should be appreciated that any suitable patient terminal would beacceptable, so long as the features of the terminal are known by thesystem. Preferably, the system includes a terminal with a resolution of800×600 DPI, a second terminal (such as a smart phone-type device) withan input device (such as touch sensing capabilities), and with theability to run a web browser. Moreover, any suitable space may be usedto conduct the testing. Preferably the testing space would be a roomwith at least 15 feet of linear walking space and the ability to darkenthe room by dimming lights or closing blinds/curtains. It should beappreciated that these system recommendations are merely recommendationsto make the system easier to use and more convenient for the patient,but that any suitable space or device may be used.

It should be appreciated by one of skill in the art that the static(i.e. non-dynamic) figures and diagrams described above with referenceto the figures are also capable of being used in the form of physicalmedia, such as paper, poster, plastic, or other printed forms. In suchembodiments, the physical media may be displayed to the patient at anysuitable location, such as at their home, at an office, or at acorrective lenses retail establishment. The physical media may be viewby the patient alone, or may be viewed with the assistance of one ormore other persons, such as an assistant or doctor. Further, in suchembodiments, the results may be entered into a terminal as describedabove for the determination of the appropriate prescriptionmeasurements.

It should be understood that various changes and modifications to thepresently preferred embodiments described herein will be apparent tothose skilled in the art. Such changes and modifications can be madewithout departing from the spirit and scope of the present subjectmatter and without diminishing its intended advantages. It is thereforeintended that such changes and modifications be covered by the appendedclaims.

The invention is claimed as follows: 1: A non-transitory computerreadable medium including a plurality of instructions, which whenexecuted by at least one processor, cause the at least one processor tooperate with a remote terminal and a handheld terminal to determine acorrective lenses prescription for a patient by: receive, in an onlineportal, a first message to begin a session from the remote terminal;responsive to the first message, start the session; receive, in theonline portal, patient information including a prior corrective lensesprescription; receive, in the online portal, a second message includingan electronic address of the handheld terminal; transmit a message tothe handheld terminal using the electronic address, the messageincluding a link to the session; receive, in the online portal, aconnection request from the handheld terminal; associate the handheldterminal and the remote terminal with the same session after receivingthe connection request; use the prior corrective lenses prescription toselect eye examination diagrams for the session, the eye examinationdiagrams associated with corresponding input interfaces; during thesession, cause the eye examination diagrams to be sequentially displayedby the remote terminal while causing the corresponding input interfacesto be displayed by the handheld terminal; during the session, receive atleast one input from the input interface displayed by the handheldterminal and associate the received at least one input to the currentlydisplayed eye examination diagram; determine the corrective lensesprescription using the received inputs in relation to the correspondingeye examination diagrams; and transmit information to the handheldterminal or the remote terminal that is indicative of the eyeexamination diagram.